Appendix C
Committee’s Calculations to Determine the Impact of the Decreased Density of Primary Care Physicians Between 2005 and 2015
Assumptions:
Rural population: 46 million (Cromartie et al., 2020)
U.S. total population: 331 million (U.S. Census Bureau, 2021)
Life expectancy: 78.6 years (Arias and Xu, 2019)
Loss of primary care physicians (PCPs) from rural counties between 2005 and 2015: –7.0 per 100,000 population (Basu et al., 2019)
Loss of PCPs in the United States overall between 2005 and 2015: –5.2 per 100,000 population (Basu et al., 2019)
+10 PCPs per 100,000 population is associated with an increase of 51.5 days of life expectancy per person (Basu et al., 2019)
IMPACT OF LOSS OF PRIMARY CARE PHYSICIANS IN RURAL COUNTIES, 2005–2015
If +10 PCPs per 100,000 population = 51.5 days of gained life per person
–7 PCPs per 100,000 population = 51.5 × .7 = 36.05 days of potential life lost per person
46 million people × 36.05 days = 1,658,300,000 days of potential life lost between 2005 and 2015
1,658,300,000 days / 365 = 4,543,287 years of potential life lost between 2005 and 2015
4,542,287 / 10 = 454,328 years of potential life lost per year
454,328 years of lost life per year / 365 days = 1,245 years of potential life lost per day
454,328 years of life lost per year; 1,245 years of potential life lost per day
If the average life expectancy is 78.6 years, 454,328/78.6 = 5,780 potential lives lost per year 1,245 per day / 78.6 = 15.84 potential lives lost per day
IMPACT OF LOSS OF PRIMARY CARE PHYSICIANS IN THE UNITED STATES, 2005–2015
If +10 PCPs per 100,000 population = 51.5 days of gained life per person
–5.2 PCPs per 100,000 population = 51.5 × .52 = 26.78 days of potential life lost per person
331 million people × 26.78 days = 8,864,180,000 days of potential life lost between 2005 and 2015
8,864,180,000 / 365 = 24,285,425 years of potential life lost between 2005 and 2015
24,285,425 / 10 = 2,428,543 years of potential life lost per year between 2005 and 2015
2,428,543 / 365 days = 6,654 years of potential life lost per day
2,428,543 years of potential life lost per year; if the average life expectancy is 78.6 years, 2,428,543 / 78.6 = 30,897 lives lost per year; 6,654 / 78.6 = 85 lives lost per day
A typical commuter plane carries 200 passengers (180 passengers in a Boeing 757; 250 passengers in an Airbus); 200 passengers / 85 lives lost per day = roughly one 200-person plane crashing every 2–3 days
REFERENCES
Arias, E., and J. Xu. 2019. National vital statistics reports: United States life tables, 2017 (vol. 68, no. 7). Hyattsville, MD: National Center for Health Statistics.
Basu, S., S. A. Berkowitz, R. L. Phillips, Jr., A. Bitton, B. E. Landon, and R. S. Phillips. 2019. Association of primary care physician supply with population mortality in the United States, 2005–2015. JAMA Internal Medicine 179(4):506–514.
Cromartie, J., E. A. Dobis, T. P. Krumel, D. McGranahan, and J. Pender. 2020. Rural America at a glance: 2020 edition. Washington, DC: U.S. Department of Agriculture.
U.S. Census Bureau. 2021. U.S. and world population clock. https://www.census.gov/popclock (accessed January 13, 2021).
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