Years ago I had a great primary care physician. One day I drove to his office and saw him assisting an elderly man walk to his car. Dr. Ingram could have asked his nurse to assist the patient. He could even have ignored the frail patient’s unsteady gait and let him fend for himself. Yet, Dr. Ingram personally helped his elderly patient make it to his car. That impressed me immensely. Not only did he treat the man’s health complaint, he made sure his patient got safely out of the office and on his way home. Nobody paid him for that, he did it out of his desire to help people.
Dr. Ingram retired years ago and I had to find another primary care physician. I found Dr. Craig and liked him a lot. Dr. Craig never seemed to be in a hurry, and he was perfectly fine when I wanted to bypass his lab and use one where I know the price. A couple years ago I needed an appointment and called his office. A staff member told me he was retiring in two weeks and was fully booked until then. I’m now looking for a new primary care physician.
It is increasingly difficult to find a traditional primary care physician. Elisabeth Rosenthal, a non-practicing physician who became a health writer, noticed a tread of readers contacting her complaining of their inability to find a doctor:
I’ve been receiving an escalating stream of panicked emails from people telling me their longtime physician was retiring, was no longer taking their insurance, or had gone concierge and would no longer see them unless they ponied up a hefty annual fee. They have said they couldn’t find another primary care doctor who could take them on or who offered a new-patient appointment sooner than months away.
Only about one-quarter of physicians treating adults work in primary care. Roughly 100 million people don’t have a usual place for care. For their part, primary care physicians complain of an inadequate fee structure that rewards surgeries and procedures but not the doctors helping keep patients out of the hospital. To some degree the AMA has a hand in how much primary care physicians earn compared to surgeons through what’s known as relative value units (RVUs). These values aren’t based on supply and demand, rather they’re based on what physicians in medical society leadership positions think each specialty is worth compared to others. Primary care is not respected among physicians in leadership positions. A physician told me in medical school the pressure to specialize starts early. Medical students are steered away from primary care by instructors and mentors. More from Elizabeth Rosenthal:
But the dispirited feeling that drives doctors away from primary care has to do with far more than money. It’s a lack of respect for nonspecialists. It’s the rising pressure to see and bill more patients: Employed doctors often coordinate the care of as many as 2,000 people, many of whom have multiple problems.
When you find a primary care physician, he or she may not be one you like. The reason is because private equity firms and hospitals are buying physician practices and turning them into assembly lines of 8-minute patient visits, with expensive recommended services you may not need. The doctor is paid to do his/her employer’s bidding, not advocate for their patients. According to Rosenthal:
There had been hope that nurse practitioners and physician assistants might help fill some holes, but data shows that they, too, increasingly favor specialty practice.
It’s not just that NPs and PAs don’t want to work in primary care. The AMA and physicians themselves largely oppose granting mid-level medical professionals the right to practice independently. Also, in some years there are 10,000 medical school graduates who fail to match to a residency, because Medicare-funded residencies were capped in 1997. Many of these will never be able to match, will never finish their training and will never practice medicine. Thousands more (mainly from other countries) don’t bother to apply for residency because they know the obstacles are too great. A few states are creating a new practitioner called Assistant Physicians (not to be confused with physicians’ assistants) for medical graduates who don’t match to a residency. These are often temporary, time-limited positions that will never lead to practice authority.
There are numerous medical professionals, including medial school graduates, physicians trained and working in other countries, NPs and PAs who would love to practice primary care but aren’t allowed to. That should change.