Why Is It So Darned Hard to Find a Family Doctor? (free issue)
Primary care physicians are becoming an endangered species
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Whether you call them family doctors, general practitioners, or primary care physicians, they’re becoming harder to find. In days past, everyone seemed to have a family doctor or had access to one should they need medical care. But with fewer doctors choosing to work in primary care, fewer people have this access. And it’s going to get worse.
Primary care physicians (PCPs) specialize in family medicine, general internal medicine, or general pediatrics. They are often the front-line doctors who ensure their patients’ health and wellness. They advocate for their care, coordinate care with specialists when needed, and follow up accordingly. They have an essential role in the medical system, yet those who need to see a PCP either can’t get in for an appointment or don’t have a PCP and can’t find one who is taking new patients.
Why is this happening and what can we do about it?
More people are getting older
Americans are getting older. According to the Urban Institute, in the year 2000, one in eight Americans were 65 or older. The number will more than double over the next four decades to about one in five. This means there will be 80 million so-called seniors by 2040.
Of course, getting older doesn’t necessarily mean poor health, but it is a fact that many people over the age of 65 develop chronic illnesses – many of which could be prevented.
More older people means more need to see a doctor. They also need to spend more time with their doctor if they have multiple health issues. A 15-minute slot is often not enough to talk about one problem, let alone extras. No doctor? This means no preventative care, no catching something in its early stages, and no care unless it’s an emergency.
Growing divide between rural and urban areas
Rural areas have a more challenging time recruiting young doctors. The Association of American Medical Colleges published an article in 2020 addressing this problem. In it, the author wrote, “Encouraging young doctors to take up rural practice is challenging for several reasons. Rural areas offer fewer opportunities for working spouses, and schools in rural communities may have fewer resources. Young doctors also may worry that they will earn less, which is a serious concern for those with major student debt.”
Add to this, practices that are too full to take on new patients and the difficulty rural residents may have to get there even if they can get an appointment. They need reliable transportation. And if the doctor is several towns away, they have to have the time to go.
But some urban areas are suffering too. Medically underserved areas exist in cities big and small, notably inner city areas. Doctors may prefer to practice elsewhere. For those who do practice in medically underserved areas, they – like their rural counterparts – have to have time to see their patients, and their patients have to be able to reach them.
Family medicine has lost its spark
Specialties are exciting. They are constantly evolving with new treatments and technology. Research abounds as academic institutions try to stay on top. But family physicians? They don’t feel quite as special these days so medical students don’t find primary care to be an appealing option. Some comments about family medicine from medical students, gathered for this article, include:
Family medicine is boring.
Family medicine is a lower status.
Family medicine isn’t proper medicine.
Over the years, I’ve heard people call family doctors the jack of all trades or the gatekeeper.
Some medical students think about going into family medicine, only to decide later that there might have been better choices. This op-ed shows why. The author wanted to be a family doctor, but his experience in residency drained him and made him second-guess his plans. While the author did ultimately stay in the field, he gives good examples of why some may not.
And then there are the finances
Family medicine doesn’t pay as well as specialties. Financial consideration is important when choosing any profession, even medicine. It’s not cheap to become a doctor in the United States. Most medical students have at least an undergraduate degree before medical school, which can cost over $60,000 per year – not taking into account living costs as well. Since medical school is usually four years, future doctors are looking at a minimum of $240,000. Medical school is too demanding to take on a part-time job, so either you have a lot of money saved up or access to scholarships and bursaries – or you take out loans. Lots of them.
Once they graduate, newly minted doctors must spend several years working as residents, which is on-the-job training under more experienced residents and staff doctors. They get paid for this work, which can last from three to seven years depending on the specialty, but salaries range from about $49,000 to $70,000. Residents often must start repaying their student loans at this point. If they defer the loans, interest builds up, increasing their debt load later.
Fast forward to when residency is complete and it’s time to start practicing family medicine. How much money will they earn? No doubt, the average salary is above many of those reading this newsletter, but the number only tells a small part of the story. According to the American Academy of Family Physicians, a family doctor's average salary in 2020 was $234,000 per year. But that’s not what they bring home. If they run their own practice, they must pay for salaries, equipment, rent, and the ever-rising insurance rates, among other costs. If the family doctor delivers babies, insurance rates are even higher.
So you can see that there is no one definite reason why we have a shortage of primary care physicians, or family doctors. It’s a combination of problems. But we have to figure out what we can do to mitigate these issues sooner than later because we need them. Nurse practitioners and physician associates are trying to fill the gaps, but we still need family physicians to keep our healthcare system working.
How about you? Are you having trouble finding a primary care physician? Leave your comment below. Let’s get a conversation going.
If you would like to read more about this issue, I wrote a 2-part series for Decipher Your Health back in March. Part 2 addresses the roles of nurse practitioners and physician associates.
Finding a Healthcare Provider Can Be Hard – Part 1 of 2
Finding Primary Care Providers Can Be Hard – Part 2 of 2
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