In this article, Forbes reporter Bruce Japsen reports on the American Academy of Medical Colleges annual physician workplace report, which notes the growing decline of primary care physicians in the United States year-over-year.

Forbes: Doctor Shortage Worsens, Particularly In Southern States

There are 91 active primary care physicians per 100,000 population in the United States, but there needs to be more if Americans are going to get the right care, In the Right place and at the right time, a group representing the nation’s medical schools and teaching hospitals says in a new report.

The Association of American Medical Colleges (AAMC) this week released its annual physician workforce report, which looks at the Supply and makeup of U.S. physicians, as well as the general expanding state of graduate medical education in the U.S. The report drew on data that includes information from AAMC researchers as well as the American Medical Association’s “Masterfile.”

While it’s been well documented that the U.S. needs more doctors, the report shows much of the country is in need of primary care physicians and their numbers aren’t on the Rise despite increasing emphasis on outpatient care and wellness. The flat to falling number of primary care doctors comes as more Americans can pay for treatment and are flocking to healthcare providers thanks to the Affordable Care Act.

Primary care doctors, which include internists, family physicians and pediatricians, are critical to managing chronic conditions to ensure Americans are getting the care they need to avoid bad health outcomes and higher costs that go when patients get sick and end up in the hospital. The median number of “active primary care physicians” has steadily fallen to 90.4 per 100,000 from 91 in 2010.

“We do have concerns when the numbers get below 100 primary care physicians per 100,000 people,” Dr. Atul Grover, AAMC’s chief public policy officer, said in an interview. “I’m worried people aren’t going to have access to primary care.”

Medicare and private health insurers like Aetna AET -1.85%, Anthem ANTM -0.71% and UnitedHealth Group UNH -0.85% are pushing value-based care models that emphasize primary care, wellness and outreach to populations.

But across the country, there is one primary care doctor for every 1,100 people and Grover said anything below a doctor per 1,000 Americans isn’t good. Most U.S. states except those in the northeast and certain states in the upper Midwest like Minnesota and Michigan have fewer than 100 primary care doctors per 100,000 people.

By comparison, southern states are severely lacking and tend to have a greater need. Texas, Oklahoma, Georgia, Arkansas, Alabama and Mississippi not only have low numbers of primary care doctors, but analysts say these areas tend to have high rates of obesity and chronic conditions like hypertension and other risk factors for heart disease.

There were 11 states with 64 to 78 primary care physicians per 100,000 people with Mississippi scoring the worst with just 64.5 physicians per 100,000 Americans. By comparison, Massachusetts was at the top, with 133.9 primary care physicians per 100,000 people.