On April 1, 2014, Michigan expanded access to Medicaid to people whose income was less than 138 percent of the Federal Poverty Level, or about $32,900 for a family of four.1 As of December 2014, over 470,000 Michiganders had enrolled in the expanded Medicaid program, known as Healthy Michigan,2 and over 270,000 Michiganders had enrolled in coverage through the Affordable Care Act’s Individual Marketplace.3 After Massachusetts expanded health insurance coverage in 2006, demand for primary care exceeded supply,4 raising the question of whether Michigan’s primary care providers have been able to keep up with increased demands for care after the Medicaid expansion. In order to understand the current and anticipated capacity of Michigan physicians to take new patients, particularly those with Medicaid, the Center for Healthcare Research & Transformation (CHRT) collaborated with University of Michigan faculty to survey primary care physicians across the state about their practices, compensation models, and patient populations in late 2013 and early 2014 (2014 Michigan Physician Survey). CHRT collaborated with the Child Health Evaluation and Research Unit to conduct a similar survey in 2012, which provided comparison data.5
- Michigan’s primary care physicians reported that they have the capacity to accept new patients—87 percent of Michigan primary care physicians reported that they were accepting new patients at the time of the survey.
- More physicians reported accepting new Medicaid patients when surveyed in 2014 than did so in 2012—from 2012 to 2014, the share of physicians taking new Medicaid patients increased by almost one-fifth (19 percent), from 54 percent in 2012 to 64 percent in 2014.
- Physicians reported that they expect the trend to continue and grow in the next year—22 percent of respondents expected their payer mix to include more than 30 percent Medicaid patients in the year following the survey, compared to the 15 percent who currently saw this high a volume of Medicaid patients (an increase of 45 percent).
As more Michiganders become insured, the demand for primary care is likely to rise. The 2014 Michigan Physician Survey found that Michigan providers have the capacity to accept new patients: almost nine out of ten primary care physicians (87 percent) reported that they were taking new patients. Physicians who had been practicing less than ten years were 18 percent more likely to report accepting new patients than those who had been in practice over 20 years. Figure 1 Characteristics such as region of the state, compensation, and practice arrangement were not significantly related to taking new patients.
FIGURE 1: Share of Physicians Accepting New Patients, by Time in Practice
Source: 2014 Michigan Physician Survey
FIGURE 2: Change in Proportion of Physicians Accepting New Patients, by Insurance Type
Source: 2012 Michigan Physician Survey and 2014 Michigan Physician Survey
Compared to current patient mixes, more physicians expected to see a high volume of Medicaid patients in the year following the survey. At the time of the 2014 survey, 52 percent of physicians reported seeing a low volume (<10 percent) of Medicaid patients, 33 percent reported seeing a moderate volume (10–30 percent) of Medicaid patients, and 15 percent reported seeing a high volume (>30 percent) of Medicaid patients. When asked about their expectations for the next year, 22 percent fewer physicians expected to see a low volume of Medicaid patients and 45 percent more physicians anticipated a high volume of Medicaid patients. Figure 3
FIGURE 3: Present and Anticipated Patient Volume, by Type of Insurance
Source: 2014 Michigan Physician Survey
Michigan primary care physicians’ actions and expectations have changed dramatically in the past two years. Compared to 2012, far more physicians in 2014 reported seeing Medicaid patients or expecting the Medicaid portion of their practice to grow over time. This change may reflect both the considerable increase in the state’s population covered by Medicaid as well as the reality that health care utilization has declined coincident with the recession,6 freeing more room in physician panels and allowing these physicians to accept more new patients.
2014 Michigan Physician Survey:
The survey data presented in this brief were produced from a mail survey of 1,000 primary care physicians practicing in Michigan, conducted between December 2013 and April 2014. Potential respondents received up to three mailings, with $5 included in the first mailing to encourage response. The physician sample was randomly generated from the American Medical Association (AMA) Physician Masterfile, a comprehensive list that includes both AMA members and non-members. The final sample included physicians from two primary care specialties: family medicine and internal medicine. They survey had a response rate of 36 percent (317 physicians) and has a margin of error of ±5.5 percent. Physicians who responded but reported they were no longer practicing primary care were removed from the analysis. Results were analyzed using SAS 9.3 software.
2012 Michigan Physician Survey:
Comparison data presented in this brief were produced from a mail survey of 1,500 primary care physicians practicing in Michigan, conducted between October and December 2012. Potential respondents received up to two mailings, with $5 included in the first mailing to encourage response. The physician sample was randomly generated from the AMA Masterfile. The final sample included 500 physicians each from three primary care specialties: pediatrics, family medicine, and internal medicine. Pediatricians were removed from this analysis to permit direct comparability among physicians who provide care for adults. Family physicians had a response rate of 53 percent and internal medicine physicians had a response rate of 45 percent. This analysis has a margin of error of ±4.6 percent. Results were analyzed using SAS 9.3 software. Statistical significance of bivariate relationships was tested using z tests or chi-square tests for independence. All reported differences are statistically significant at p ≤ 0.05 unless otherwise noted.
Given the sampling methods used in the two physician surveys, some respondents may have been included in both the 2012 and 2014 surveys; because of the de-identified nature of responses, it was not possible to identify physicians who responded to both surveys. Response rates differed by medical specialties between surveys: internal medicine physicians were more likely to respond in 2012 than in 2014 and family medicine physicians were more likely to respond in 2014 than in 2012.
Suggested Citation: Smiley, Mary L.; Riba, Melissa; Davis, Matthew M.; Kerr, Eve A.; Zikmund-Fisher, Brian J.; Ndukwe, Ezinne G.; Ward, Melanie; Udow-Phillips, Marianne. Primary Care Capacity in Michigan: How are Physicians Responding?. 2014 Michigan Physician Survey. (Ann Arbor, MI: Center for Healthcare Research & Transformation, 2014).
Special thanks to Knoll Larkin for assistance with survey administration and to Thomas Buchmueller, Robert Goodman, Helen Levy, and Renuka Tipirneni for assistance with survey development and interpretation.