Imagine this: You just became insured and are now in search of a primary care physician (PCP). After making calls to several local providers you find that no one has an opening for you in their practice. This is confusing as you believed that becoming insured would allow you to receive basic medical care.
According to a WBUR Boston, Inside Out Documentary called “The Doctor Can’t See You Now” many people are finding themselves in this position. There are fewer and fewer primary care physicians available nationwide.
This problem is being dubbed the “primary care crisis.”
The Scope of the Problem
While stories about people being turned away may seem to be few and far between, recent reports suggest the problem is in fact widespread.
- The National Association of Community Health Centers (NACHC) estimates that we need up to 60,000 more primary care physicians to provide services to those currently without medical care.
- At the same time, medical schools have seen a 22 percent drop in the number of students who chose to become generalists rather than specialists over the past decade.
- The American Board of Internal Medicine released a study showing that after 10 years of initial board certification, approximately 21% of general internists were no longer practicing in their field, compared with 5% leaving a specialist practice.
- The American Academy of Family Physicians predicts that 40,000 more PCPs will be needed by the end of the decade.
- In 2007, only 1 out of 50 graduating internal residents at Massachusetts General Hospital was planning on becoming a PCP.
Where are all the PCPs?
Medical students continue to shy away from this field in favor of specialty medicine. This choice is influenced by the economic realities of our current system.
- Many medical students have over $100,000 in debt upon leaving medical school, Specialty careers generally pay about $100,000 (at the least) more per year than do primary care positions, according to the Annals of Internal Medicine.
To meet financial and patient demands, PCPs often try to squeeze in as many patients as possible on a daily basis, leading to 15 minute (or less) appointments. Many PCPs also cite large amounts of paperwork, long work days and lack of prestige as factors contributing to low satisfaction rates.
Solutions: Short and Long-Term
In the long-term, policymakers might consider making changes to the pay-scale for all doctors.
- Changing the pay-scale for PCPs is a politically tricky issue, as there is only a set amount of money available for all medical payments. For PCPs to make more money, other types of doctors would see their paychecks reduced. Bob Wachter, Professor and Associate Chairman of the Department of Medicine at the University of California, San Francisco (UCSF) , and author of Wachter’s World describes this situation in more detail.
Medical schools can also help by granting tuition reductions:
- Some schools, including the University of Massachusetts, are offering tuition breaks for students who commit to a career in general medicine. These programs could go a long way towards helping students reduce massive medical school debt.
In the short-term, providers are experimenting with new models of primary care delivery that can hopefully serve more patients with fewer doctors. Community Health Centers (CHCs), for example, are popping up nationwide.
- CHCs work by assembling a team of doctors, nurses, nurse practitioners and physical therapists. The tasks of a primary care visit are divided up amongst the team, which allows the doctors more time to address serious problems. The other professionals then follow-up with the patients on medication, diet and exercise plans.
It’s been shown repeatedly that treating someone in a primary care setting is vastly cheaper for all of us than having that same person go to the emergency room. Unfortunately, unless primary care is made to be a more desirable choice for medical students, we will continue to see both uninsured and insured individuals visiting ERs for lack of other options.
Read more about this problem in this extensive American College of Physicians report.