Lisa Rotenstein Awarded R01 to Investigate Primary Care Workforce Crisis and Its Toll on Older Adults

Comprehensive, continuous, and coordinated primary care delivers proven benefits for older adults, from higher rates of appropriate preventive care to lower rates of hospitalization and mortality. These benefits are now threatened by an impending primary care workforce crisis driven by prevalent trends of clinician burnout, workforce attrition, and reductions in clinical effort among primary care clinicians

DoC-IT's Lisa Rotenstein, MD, MBA, MSc, was recently awarded an R01 grant from the National Institute on Aging to address this crisis. The project, titled "The Impact of Changes in Primary Care Clinicians' Work Effort on the Health of Older Adults," will investigate how disruptions to the primary care workforce affect the quality, continuity, and accessibility of care for older adults in the United States.

Conducted alongside co-principal investigator Bruce Landon, MD, MBA, MSc, from Harvard University, the project will use data from Medicare fee-for-service and Medicare Advantage programs, which together cover approximately 93% of older adults in the US. Drs. Rotenstein and Landon will pursue three interconnected aims: 1) identifying which Medicare patients are affected by clinician turnover and sustained reductions in billed clinical effort; 2) assessing how those changes affect patterns of primary care receipt, emergency department visits, and hospitalizations; and 3) measuring the downstream impact on quality of care.

The study will give particular attention to vulnerable subgroups, including older adults with dementia, those managing multiple chronic conditions, and individuals dually eligible for Medicaid. Analyses will also compare outcomes before and after the COVID-19 pandemic, which was a period of acute stress on the primary care workforce. It will also separately examine physicians and advanced practice clinicians, which includes nurse practitioners and physician assistants to surface any differential effects.

“As primary care clinicians seek to balance the demands of patient care, they often cut back on the time they spend seeing patients,” said Dr. Rotenstein. “This grant will enable us to study this phenomenon nationwide and its downstream impact on patients.”

The findings are expected to generate actionable insights for designing clinical systems and workforce policies that support primary care clinician retention and protect the quality of care delivered to America's growing older adult population.

This award is supported by the National Institute on Aging. View the RePORTER page project details here.