The Patient Panel Size Dilemma: What a Decline in Panel Size Means for the Future of Family Medicine

In the last decade, the specialty of family medicine has witnessed an interesting trend: the average patient panel size among family physicians has decreased significantly. According to a recent policy brief titled, ‘Self-Reported Panel Size Among Family Physicians Declined by Over 25% Over a Decade,’ panel size decreased from an average of 2,400 patients cared for in 18 months to just over 1,700 between 2013 and 2022.

The brief was published on the Journal of the American Board of Family Medicine (JABFM) website.

Today, we delve into the expert insights of Dr. Andrew Bazemore, American Board of Family Medicine (ABFM) Senior Vice President of Research and Policy, and Dr. Kevin Grumbach, Professor of Family and Community Medicine at University of California San Francisco (UCSF), who authored the policy brief alongside ABFM Research Data Analyst Zachary Morgan, to better understand this phenomenon and its implications on the future of family medicine.

“Panel size is this term for patient populations that one family physician and his or her team serve, and we’re trying to put a number to that,” said Dr. Bazemore. If you don’t have a manageable number of people that you’re taking accountability for, it’s really hard to advance quality care. If you have too many patients, you get the access crisis we have right now, or you make it actually worse. It becomes harder to do all the things we want to do from prevention to acute to chronic disease care.”

Dr. Grumbach expanded on that idea and described the research findings. “The average number of patients that a family physician is taking care of over the past decade has dropped by about 25%. Meaning, to me, that people are just realizing they can’t take care of as many patients as they’ve been expected to take care of in the past. It’s the reason for such high burnout among family physicians and others working in primary care. So, there has been, I think, a very logical movement to take care of fewer patients.”

Both physicians agreed that appropriate patient panel size is entirely dependent on the individual circumstances of a physician’s practice. Dr. Bazemore referenced the guidance of UCSF’s Center for Excellence in Primary Care. “They said, ‘[The right panel size] is really one that allows a clinician and associated care team to work to their fullest capacity while meeting the population’s need for access, quality of care, and patient experience.’”

Dr. Bazemore continued, “There are going to be those who can care for higher panel numbers and those who need to go for smaller numbers. There are going to be different ways of approaching relationships. There are differences in panel size across gender, region, the type of institution you work for, etc. That kind of variation is both normal and desirable. This trend, this 10-year drop, is probably bringing family medicine panel size closer to where it should be.”

The policy brief states that approximately 30,000 family physicians from across the country were surveyed to determine this data set. Ongoing surveillance of trending data will continue, and an updated study analysis will be published in 2025.

“How do we then support primary care to meet the needs of the public?” asked Dr. Grumbach. “I think the Board, and the other family medicine organizations, have all coalesced around this fundamental need to increase investment in primary care. Nothing is going to improve without that higher investment. Otherwise, we’re just tinkering in the margin.”

More data on these results will soon be released, including another paper exploring the dimensions of panel size variation.

“It’s really important in an age when we’re talking not only about access but equitable access. Panel size, if its shrinking, may really challenge areas that have the least primary care physicians,” said Dr. Bazemore. “On the flip side, we also know that patients who are the most vulnerable are probably the ones who need the most relationship attention. The most broad teams and smaller panel sizes are what we should be aiming for to care for the patients with the greatest needs. We’re going to be diving into that more in future papers.”

The decrease in panel size among family physicians is a significant issue with far-reaching implications for patient access. Thank you to Dr. Grumbach and Dr. Bazemore for providing their personal insights from the policy brief research and offering suggested pathways for how this change can be mitigated when providing care to patients. These findings serve as a crucial call to action for policymakers, health care leaders, and the public to prioritize investments in primary care and support efforts to enhance access and quality of care for all patients. Please visit the full policy brief for further insights into this research and pathways to better patient care.

Aaron Burch serves as Editorial Content Manager for the American Board of Family Medicine. He has been writing professionally in the health care field since 2014.