Where U.S. Women Receive Primary Care: A Cross-Sectional Analysis

Background

Despite national primary care access challenges, some women receive primary care from both general medicine and obstetrics-gynecology (ob/gyn). The extent and potential implications of this phenomenon are unclear.

Objective

To evaluate primary care use among US women and identify characteristics and service receipt associated with visits to both general medicine (e.g., general internal medicine, family medicine, pediatrics, geriatrics) and ob/gyn.

Design

Retrospective descriptive study using 2012, 2017 and 2022 data from the nationally representative Medical Expenditure Panel Survey.

Participants

Non-pregnant women aged 19–85 years.

Main Measures

Visit pattern (visits to general medicine only, ob/gyn only, both, another specialty only, no visits), usual source of care, service receipt.

Key Results

Of 9,297 respondents (weighted = 125,485,789), 29.2% reported no usual source of care in 2022; 20.3% had no visits in 2022, an increase from 18.9% and 18.2% in 2012 and 2017, respectively (p-value = 0.03). Most 2022 respondents (53.8%) saw general medicine only, 3.4% saw ob/gyn only, 10.4% saw both, and 12.0% saw another specialty only. Among women who saw both specialties, 65.4% reported a general medicine clinician and 2.1% reported an ob/gyn clinician as their usual source of care. In multivariable models, compared to those with other visit patterns, women who saw both specialties had higher education levels (adjusted relative risk (aRR) 2.48 (95% CI 1.49, 4.13) for master’s/doctorate degree vs. no degree) and were more likely to have insurance (private, public, Medicare) vs. no insurance (aRR 4.89 (2.47, 9.67), 4.21 (2.00, 8.88), 3.81 (1.61, 9.02), respectively). Seeing both specialties was associated with higher rates of potentially low-value lab testing and imaging, and both guideline-discordant and guideline-concordant Pap smears and mammograms.

Conclusions

One-fifth of nonpregnant adult women had no visits in 2022, while 10% received primary care from two sources, suggesting gaps and redundancies in primary care that could exacerbate access limitations and widen health inequities.