The Disappearing Docs in Primary Care

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The Disappearing Docs in Primary Care

The Disappearing Docs in Primary Care

If you thought it was tough now to get a quick appointment with your primary care doctor for minor procedures (vaccinations, blood tests, work physicals and the like) or for urgent care, it's going to get even worse and stay that way.  This is one of the driving forces behind the high demand for care in a modern, professional facility like Brookside Urgent Care Center.
In the field of primary care, there is no light at the end of this tunnel.  It just gets darker and darker.

The New York Times ran a story in 2012 titled “Doctor Shortage Likely To Worsen With Health Law.” The story originally focused on Riverside County.  But it – combined with what happened in Massachusetts with RomneyCare – will give us all an idea of the magnitude of this problem.

In Riverside, CA, for example, the Affordable Care Act (ACA) is expected to extend insurance coverage in that area to more than 300,000 people by 2014 – according to the New York Times article.  But new coverage will not necessarily translate into primary care: Local health experts doubt there will be enough doctors to meet the area’s needs.  There aren't even enough to meet the current demand in 2013.

If we use the universal care program in Massachusetts as any kind of a guide, ABC News reports that that wait time to see a primary care physician is in Boston is a staggering average of 50 days.  And that's if you can even get an appointment at all.  New patients with ACA insurance plans will often find they can't even get into a primary care practice.  About half of primary care physicians in Massachusetts are closed to new patients this year, reflecting only slight improvement over the past two years, according to the Massachusetts Medical Society's 2012 Patient Access to Care Study.

Even without the Affordable Care Act, the shortfall of doctors in 2025 would still exceed 100,000.  The report quoted Dr. Kevin Pho, an internal medicine physician in Nashua, N.H. Who said, "That situation, extrapolated to the rest of the country, it has the potential to make for some very long wait times for primary care," said  "It's going to significantly press our primary care system."  Pho said he has seen patients who reside in northern Massachusetts coming over the state line to New Hampshire for their care because of the wait times.

Pho also shared one of his major concerns about the new health care law.  In addition to reimbursements paid to primary care doctors still being way below those of specialists, physicians who run a family practice often work long hours with little down time. The result isn't pretty.  He pointed to a study published last year in the Annals of Internal Medicine, indicating that over 25 percent of physicians surveyed were reporting burnout.  Pressures included time and lack of control over work.

The entirety of Americans seeking medical care will face ever increasing challenges.  The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed.  That number will more than double by 2025, as the expansion of insurance coverage and the aging of baby boomers drive up demand for care.
If you're having trouble getting into see your primary care physician now, just imagine how tough it will be to see your doctor starting in the near future.  It's easy to point out the problem.  You may be surprised to find out the true reason for the primary care doctor shortage.  Just like in a criminal investigation, follow the money.

The average medical student finishes his or her education almost $150,000 in debt.  The debt can be paid while earning less than $200,000 per year as a family practitioner, or the debt can be retired while earning a specialist's salary which will be twice or three times that amount.  Which would you choose?

Look at it another way.  Primary care physicians find their day doesn't last 8 hours, or even 10 hours, but often many more hours than that. While specialists may also find themselves working extended hours, they won't do so as often.  If you could pick a pathway to being a specialist who worked a 50-hour week for $400,000 a year, or pick the path that leads to a family practitioner who put in 80-hour weeks for half that amount of money, which fork in the road would you take?

The result is that only only one in five graduating medical residents plan to go into primary care, according to the Journal of the American Medical Association.  The results of a recent study, published online in the journal Medical Care, clearly showed the different income levels.  J. Paul Leigh, lead author of the study, professor of public health sciences and researcher with the UC Davis Center for Healthcare Policy and Research said, "The need for primary-care providers is greater than ever before and expected to grow as millions more Americans become insured under the Affordable Care Act - "Without a better payment structure, there will be extraordinary demands on an already scarce resource."

Here's a peek into the disparity of incomes among doctors (as reported in the study noted above). Incomes were evaluated for more than 6,000 doctors practicing in 41 specialties and then merged into four broad career categories, lifetime earnings in surgery, internal medicine and pediatric sub-specialties, and all other medical specialties averaged from $761,402 to $1,587,722 higher than in primary careover the life of the medical practice. Take a look at these numbers.

  • Surgery: $4,588,249

  • Internal medicine subspecialties and pediatric sub-specialties: $4,100,183

  • All other medical specialties: $3,761,930

  • Primary care (geriatrics, family practice, general practice, general internal medicine and general pediatrics): $3,000,527


Comparing the results as 41 separate specialties, the disparities in lifetime income can become almost ridiculous.  Medical oncologists, for instance, earn up to $7,127,543 during a 35-year career, while family medicine practitioners earn as low as $2,838,637.  That's a staggering difference of about 250%.  Wouldn't a raise in pay that high be nice for anyone – especially if it could be earned with less work?

The shortage of primary care options has led to the incredible growth in facilities such as Brookside Urgent Care Centers.  We keep board-certified practitioners on site during all open hours, are open past normal working hours, on weekends and you'll be able to walk-in and be seen right away.

There are two problems that contribute to the shortage:  The low numbers of medical students who are choosing primary care as a specialty, and the increasing numbers of Baby Boomers who require more and more care as they age.