Skip to main content

US Physicians with Recent Experience Managing Hospitalized Older Adults: an Observational Study


The number of COVID-19 cases in the USA surged from zero to 1.7 million between February and May 2020.1 With predicted hospitalization rates as high as 20%,2, 3 many hospitals ramped up staffing by deploying physicians to the front lines.4 However, little is known about the supply of physicians potentially available to manage hospitalized patients with COVID-19. Over the past 20 years, US healthcare delivery shifted from predominantly facility-based to ambulatory clinic-based services, with some physicians no longer treating hospitalized patients. As hospitals face the COVID-19 pandemic, an assessment of demographics and practice characteristics of physicians likely to be deployed could inform resource allocation. For example, given elevated risk of severe disease among older adults,2 hospitals may not want to deploy older physicians to provide direct patient care. Our objectives were to (1) describe the characteristics of physicians with recent experience managing hospitalized patients, and (2) measure regional prevalence of these physicians across hospital service areas (HSAs)5.


We used the 2017 Provider Utilization and Payment Data, containing physician billings for Medicare fee-for-service beneficiaries, linked to the Medicare Physician Compare files, containing physician gender and year of medical school graduation.

First, we identified all 579,056 physicians who billed for > 10 evaluation and management visits. Because Medicare billing codes for hospital visits are the same for primary attending and consultants, we excluded specialties least likely to serve as the primary team for a medicine patient (dermatology, nuclear medicine, ophthalmology, psychiatry, pathology, and radiology) (16.8%), and emergency medicine physicians (7.4%) who are more likely to be deployed in the emergency department. We then used hospital visit (99217-99226, 99231-99236, 99238, 99239), critical care (99291, 99292), and ventilator management codes (94002-94005, 94660-94662) to identify physicians who treated hospitalized (or critically ill) patients. Lastly, we measured the prevalence of physicians per 100,000 residents in each HSA.

Variables were compared using the χ2 test. Two-sided p values < 0.05 were considered significant. Analyses were conducted using STATA 16.0 (College Station, TX). The University of Pennsylvania Institutional Review Board waived review of this study.


Of the 438,895 physicians in our sample, 44.8% provided hospital and 7.2% critical care visits. The majority were male (75.0% of physicians with hospital visits and 77.2% with critical care visits) (Table 1). Ten percent (10.2%) of physicians with hospital and 6.6% of physicians with critical care visits graduated 41 + years ago. Many performed 50 or fewer visits (17.3% for hospital visits and 43.2% for critical care visits).

Table 1 Characteristics of Physicians Who Treated Hospitalized Patients Overall and Those Who Provided Critical Care in 2017

Across the 3360 HSAs, the median number of physicians who treated hospitalized patients was 35.8 per 100,000 residents (inter-quartile range [IQR] 18.9 to 58.3). This population-based prevalence varied 7-fold between the 25% of HSAs with the highest and lowest prevalence. The median number of physicians who provided critical care was 3.4 per 100,000 residents (IQR 0 to 8.8). Forty percent (40.6%) of HSAs had no physicians who billed for > 10 critical care visits (Fig. 1).

Figure. 1

Prevalence of physicians who treated hospitalized Medicare beneficiaries requiring critical care per 100,000 hospital service area residents in 2017. The figure shows the geographic distribution of physicians who billed Medicare for critical care services in 2017 per 100,000 residents in each hospital service area.


More than half of all physicians who billed Medicare in 2017 provided fewer than 11 hospital visits. Applying additional criteria such as critical care experience, risk factors for severe COVID-19 (age > 65 based on years of experience), and minimum visit volume further reduced the estimates of physicians with recent experience potentially available to treat hospitalized patients.

This study has limitations. First, we did not assess care not covered by fee-for-service Medicare. Although very few physicians opt out of Medicare,6 some may accept non-traditional Medicare products (such as Medicare Advantage) in lieu of traditional Medicare. While Medicare Advantage plans generally restrict participants’ choice of physicians using narrower networks of participating providers compared to traditional Medicare, it is possible that our approach may slightly undercount the number of available physicians. Second, we did not account for willingness of physicians to change their practice during a pandemic. Third, we did not count trainees who provide a crucial component of hospital care.

Our findings anticipate a shortage of physicians with recent experience managing hospitalized patients with critical care needs during a pandemic, particularly in some areas of the country. Planning efforts should include strategies to mitigate this shortage, including the use of telemedicine, retraining modules for physicians without recent acute hospital care experience, and ensuring that the limited healthcare workforce is protected from COVID-19 with adequate personal protective equipment.

Data Availability

Dr. Ryskina had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Dr. Ryskina conducted analyses for this study.


  1. 1.

    Centers for Disease Control and Prevention. Coronovirus Disease 2019. Cases in the U.S. Accessed on May 26, 2020 at

  2. 2.

    Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of Coronavirus disease 2019 in China. N Engl J Med 2020. DOI:

  3. 3.

    IHME COVID-19 Health Service Utilization Forecasting Team. Forecasting COVID-19 impact on hospital bed-days, ICU-days, ventilator days and deaths by US state in the next 4 months. MedRxiv. March 26, 2020; Accessed on April 5, 2020 at

  4. 4.

    Ramachandran S, Palazzolo J, West MG, Evans M. Coronavirus cases strain New York City hospitals: 'We're getting pounded'. Wall Street J. 2020.

  5. 5.

    Dartmouth Atlas Group. Hospital Referral Region to Zip Code Crosswalk. Robert Wood Johnson Foundation and the Dartmouth Clinical and Translational Science Institute. Accessed on April 1, 2020 at

  6. 6.

    Boccuti C, Swoope C, Damico A, Neuman T. Medicare patients’ access to physicians: a synthesis of the evidence. Menlo Park: The Kaiser Family Foundation; 2013. Accessed on April 5, 2020 at

    Google Scholar 

Download references


The authors gratefully acknowledge Hannah Wang in the Wharton Jerome Fisher Program in Management and Technology for her assistance with this research.


Dr. Ryskina’s work on this study was supported in part by the NIA Career Development Award (K08AG052572). Dr. Werner was supported in part by K24-AG047908 from the NIA.

Author information



Corresponding author

Correspondence to Kira L. Ryskina MD, MSHP.

Ethics declarations


The NIH had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Ryskina, K.L., Bhatla, A. & Werner, R.M. US Physicians with Recent Experience Managing Hospitalized Older Adults: an Observational Study. J GEN INTERN MED 35, 3747–3749 (2020).

Download citation