More Patients Visit NPs & PAs as Usual Source of Care, Primary Care

The landscape for people’s usual source of care is changing, with fewer people reporting a regular primary care provider, according to a Fast Facts report from the Employee Benefit Research Institute (EBRI).

When patients do report a usual source of care, provider types are changing, the report showed. Instead of opting for a physician, patients are visiting with nurse practitioners (NPs) and physician assistants (PAs) as usual sources of care.

A usual source of care refers to the individual clinician or facility at which a patient regularly accesses their care. While usual sources of care are usually primary care providers, experts acknowledge that patients may regard certain specialists, like ones who manage a common chronic illness, as their usual sources of care.

Having a usual source of care is recommended by the National Academies of Sciences, Engineering, and Medicine (NASEM) and can have tangible health benefits. Folks with a usual source of care are less likely to have an emergency department admission, for example.

But this report shows that patients are less likely to heed that recommendation compared to years prior, and there are racial health disparities at play, too.

In 2013, 79 percent of White people reported a usual source of care. This was the most common racial group to report a usual source of care, followed by Black people (75 percent), Asian people (72 percent), and Hispanic people (71 percent).

White people remain the most likely racial demographic to report a usual source of care, with 74 percent doing so in 2020, the most recent year for which EBRI reported data. For Asian people, that figure was 68 percent, while 67 percent of Black people and 66 percent of Hispanic people reported the same.

These racial differences may be small, but they could be reflective of further health disparities observed down the line, like higher occurrences of chronic illness among racial and ethnic minorities.

The report also looked into which types of providers patients visit as their usual sources of care, observing a tip toward advanced practice providers (APPs) over physicians. To be clear, doctors are still the most common provider type patients visit as a usual source of care. But fewer patients visit with doctors now than in 2013, while the report noted an upswing in the number of patients visiting with an NP or PA.

In 2013, only 2 percent of White people said they saw an NP or PA as their usual source of care, while 12 percent did so in 2020. For Black and Hispanic people, this increase was from 2 percent in 2013 to 7 percent in 2020.

These changing provider credentials could be reflective of expanded scope of practice laws that allow NPs and PAs to spearhead more of patient primary care, as well as an influx of NPs and PAs in the medical workforce.

The overall downswing in patients reporting a usual source of care could be a function of changing health insurance coverage, EBRI indicated. Employer-sponsored health insurance makes it easier for patients to get a primary care provider, and when those benefits aren’t there or are insufficient, patients may choose to go without.

However, there could be other factors at play. A 2023 report from the National Association of Community Health Centers (NACHC) also indicated that more Americans are going without a usual source of care, but NACHC’s report suggested that provider shortages, especially in rural areas, are to blame.

Other assessments have indicated that high healthcare costs and long appointment wait times also deter patients from obtaining a usual source of care.