Physicians Who Provide Primary Care in US Nursing Homes: Characteristics and Care Patterns

Objectives: To examine practice trends and characteristics of primary care physicians providing care in US nursing homes. Design: Retrospective cohort study using Medicare Fee-for-Service claims. Setting and participants: Physicians who provided primary care to long-stay nursing home residents. Methods: Residents were attributed to physicians based on a plurality of evaluation and management visits in a given year. Trends in the proportion of nursing home residents seen by physicians in each primary care specialty over the period 2012-2019 were examined using linear regression. Comparisons of resident, physician, and nursing home characteristics in 2019 were made using analysis of variance tests and chi(2) tests for multiple comparisons. Results: Internal medicine specialists provided care to the largest portion of nursing home residents (47.3%), followed by family practitioners (42.6%), geriatricians (4.8%), general practice physicians (2.8%), and physical medicine and rehabilitation specialists (2.5%). Geriatricians and physical medicine and rehabilitation physicians had the highest average percentage of services provided in nursing homes (63.8% and 73.0%, P < .001) and were more likely to be specialized nursing home physicians (42.0% and 61.3%, P < .001). They also tended to care for residents with more complex needs. Geriatricians were more frequently concentrated in higher-quality nursing homes with more resources, and in metropolitan areas, compared with facilities where other types of physicians provided care. Conclusions and implications: There is wide variation associated with physician primary care specialty in the amount of care provided to nursing homes residents, in the characteristics of residents treated, and in the types of nursing homes where primary care physicians provide care. Further study is warranted to determine the sources of this variation, including whether it is associated with systemic problems in nursing home care (eg, shortages of geriatricians, low clinician reimbursements, undervaluation of nursing home clinicians compared with their counterparts, malpractice liability).