Experts forecast family-doctor shortage for next decade: what you should do right now

by James Hubbard, M.D., M.P.H.

Having a good family doctor whom you trust is an efficient way to fight high health costs. You can go for most of your family’s medical treatment. They will know you, answer questions and refer you when needed. In addition, your medical information can be kept in one place, you will have someone to keep up with your tests (less likely to be redundant and drugs (potentially less interactions of meds).

But will there be enough family doctors to treat us in the future?

According to a recent article in my local newspaper, the Colorado Springs Gazette, the shortage has begun. Titled “A Family Doctor Disaster,” the article says:

There’s a shortfall in primary care physicians, which is likely to get worse in the next decade.

The estimate is anywhere from 20 to 100 fewer primary care physicians than our city of 350,000 need. Many of the available physicians no longer take new Medicare or Medicaid patients, who have no alternative but to go to over-crowded emergency rooms that are multiple-times more expensive.

Since I was in school in the 1970s this shortage has been a worry. Back then, it was thought that having the “gp” designated as a “specialty” with 3 formal years of training after medical school, certification standards, continuing education and requiring periodic re-certification would help give patients more assurance about our skills, and increase our status in the medical community. The changes have certainly increased our overall minumum standards of quality-care.

But we still have the shortage. The “celebrities” in medical school are still the super-specialists who have great knowledge in one small area of medicine. They are extremely valuable in the medical school arena where a lot of patients are referred when they need added expertise for a rare or complicated problem. Specialists who do procedures can charge much more, and get reimbursed for that surgery or endoscopy, while primary care spends most of their time with the patients to get a good history, exam, make a diagnosis with the knowledge in our head and explain the problem and treatment to the patient.

Certainly I do not make light of the specialists’ talents. I want the best cardiologist for my catheterization and the best surgeon for my bypass. But if I start out with my family doctor he/she might catch my high blood pressure, or cholesterol for early treatment that would negate my need for this. He/she might give me advice and tips to stop smoking when I come in for my lung infection, or refer me when I say, “Oh by the way, I’m having a lot of indigestion when I jog”. Some will have the expertise to actually do the heart tests and medical treatment themselves watching for drug interaction or side effects.

So, how can we encourage more family doctors to go into the field? I think we have to change the reimbursement system so that family doctors get paid more through insurances and the government. Will this happen? Very unlikely. There was an attempt by Medicare in the 1980s to do this with feeble results. Who is willing to pay more now for improvements down the road? And which specialist is going to be willing to take the cut?

So what can you do? I would starting looking for a good family doctor now. Ask friends, colleagues, call offices to see if they accept your insurance, and get a checkup to see if you personally feel comfortable they your needs will be met. Do this before you actually get sick and don’t have the time. Maybe the checkup will show something you can do to avoid getting sick in the first place. It may take several weeks to get your first appointment and get in the system. Meanwhile a freestanding, outpatient clinic that takes walk-ins is available nearby most communities. Always go to the emergency room if you have any question that yours might be an emergency.

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6 Responses to “Experts forecast family-doctor shortage for next decade: what you should do right now”

  1. Mark Salinas Says:

    Very sound advice. I definitely believe that a proactive approach is better then a reactive approach.
    Fortunately with technology we have sites such as this one, that make resources more readily available.
    Of course technology doen’t replace the doctor but it can assist in preventative measures.

    Mark Salinas
    Healthy Living Today

    Mark Salinass last blog post..Abdominal Basics

  2. James Hubbard’s My Family Doctor Blog » Blog Archive » Doctors flock to Texas after tort malpractice reform Says:

    [...] my post yesterday about the family doctor shortage, someone who follows our managing editor’s tweets [...]

  3. James Hubbard’s My Family Doctor Blog » Blog Archive » Special: Behind the scenes of latest blog post (Plus: doctors on Twitter) Says:

    [...] I linked to Dr. Hubbard’s blog post on the family-doctor shortage. One of my followers, “coloradocoach,” replied with a [...]

  4. James Hubbard’s My Family Doctor Blog » Blog Archive » CDC reports emergency room visits at record high Says:

    [...] there seems to be too few primary care physicians to give patients an alternative.  I have blogged on this in the past, but it looks like we should not look to Canada for answers on this.  Over-extended physicians [...]

  5. Dan Says:

    In recent times, others have appeared to express concern about the apparent shortage of primary care doctors in particular in the United States. Both presently as well as in the years to come, others speculate that the shortage of doctors will continue to progress to even greater absence of PCPs that what exists now. Less than 20 percent of medical school graduates go for primary care as a specialty as a residency program today. Typically, the main reason believed by many is lack of pay compared with other medical specialties. Some anticipate a shortage of 60 thousand or so primary care doctors in the future within the United States. The PCP doctors who practice right now would not recommend their specialty, or their profession, it has been reported.
    It is estimated that the U.S. needs presently tens of thousands more primary care physicians to fully satisfy the necessities of those members of the public health. Ironically, PCPs have been determined to be the backbone of the U.S. Health care system, which I believe them to be. For example, PCPs manage the many chronically ill patients, who benefit the most from the much needed coordination and continuity of care that PCPs historically have strived to provide for them. Nearly half of the U.S. population has at least one chronic illness- with many of those having more than one of these types of these illnesses. A good portion of these very ill patients have numerous illnesses that are chronic, and this is responsible for well over 50 percent of the entire Medicare budget, who are largely cared and treated by PCPs.
    The shortage of primary care physicians is possibly due to other variables as well- such as administrative hassles that are quite vexing for the physician vocation overall- along with ever increasing patient loads complicated by the progressively increasing cost to provide care for their patients due to decreasing reimbursements from various organizations the doctors receive for the services they provide. For reasons such as this, it is believed that some PCPs are retiring early, or simply seeking an alternative career path. As mentioned earlier, the PCP specialty is not desirable for a late stage medical student, so this is quite concerning to the public health in the United States. The number of medical school graduates entering family practice residencies has decreased by about half over the past decade or so. PCPs also have extensive student loans from their training to complicate their rather excessive workloads as caregivers with decreased pay, comparatively speaking.
    Despite the shortage of these doctors, primary care physicians do in fact care for the populations they serve and are dedicated to their welfare, as difficult as it may be for them at times. Studies have shown that mortality rates would decrease due to increased patient outcomes if there were more PCPs to serve those in need of treatment. This specialty would also optimize preventative care more for their patients. Studies have also shown that, if enough PCPs are practicing in a given geographical area, hospital admissions are decreased, as well as visits to emergency rooms. This is due to the ideal continuity in health care these PCPs provide if numbered correctly to serve a given population of citizens. In addition, PCP care has proven to improve the quality of care given to patients, as well as the outcomes for these patients as a result are more favorable. Most importantly, the overall quality of life for their patients is much improved if there are enough PCPs to handle the overwhelming load of responsibility they presently have due to this shortage of their specialty that is suppose to increase mildly if at all in the years to come. The American College of Physicians believes that a patient- centered national health care workforce policy is needed to address these issues that would ideally be of most benefit for the public health. Policymakers should take this into serious consideration.
    “In nothing do men more nearly approach the Gods then in giving health to men.” — Cicero
    Dan Abshear (ex-military medic and physician assistant for nearly 20 years)
    Author’s note: What has been written has been based upon information and belief of a layperson, yet also the assessments of a patient.

  6. James Hubbard, M.D., M.P.H. Says:

    Dan, those are all valid points. It is going to be very difficult to solve the shortage when you get higher pay and pretige going into a specialty.
    Thanks

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