This blog post was written by Dr. Nathan Moore, a SteadyMD team member and the author The Health Care Handbook: A Clear and Concise Guide to the United States Health Care System. Dr. Moore is a graduate of the MD program at the Washington University School of Medicine in St. Louis, Missouri and is a practicing physician.
Most experts agree that high quality primary care is the foundation of a patient’s health but good luck trying to find a good primary doctor that’s taking new patients. Today, less than 40% of practicing physicians are in primary care, compared to 70% in the 1950s, and the numbers continue to dwindle.
So, let’s take look at the reasons why.
They’re Paid Less, So Fewer Doctors are Going Into Primary Care
Physicians in the US are paid by volume and by service. Which means that seeing more patients = making more money. Performing procedures on patients, like surgery, colonoscopies, or CAT scans = making way more money. Primary care physicians spend their time doing preventive care and chronic disease management (e.g., diabetes and high blood pressure) which are reimbursed at lower rates. Overall, primary care physicians are paid 30% less than specialists.
A national committee of 31 physicians sets the recommended reimbursement rates for most medical care in the US, and more than 80% of the committee members are specialists. It makes sense, then, that the payments favor specialty care and procedures. So, in turn, to cover their overhead and salary, primary care physicians increase the volume of patients that they see and can bill for – hence, 15 minute visits where you only have time to discuss one problem.
The Paperwork is a Pain
Between documentation requirements for each visit, prior authorizations for medications and imaging tests, clearances for surgery, work and school notes, insurance form after insurance form after insurance form…it’s not surprising that primary care physicians are responsible for more paperwork than other physicians. It’s a huge drain on time and doesn’t help patients get better (which, after all, is the point of going to the doctor in the first place).
Duke University researchers estimate that, given the typical patient load and the current guidelines for care, a PCP should be spending 7.4 hours per day on preventive care, 10.6 hours on managing chronic diseases, and 4.6 hours on handling acute illness — totaling 22.6 hours a day. Obviously, when cramming 23 hours of work per day into 8 or 10 hours, some corners will be cut and others will be ignored entirely.
It’s not surprising that patient satisfaction with primary care is low and, while not entirely due to primary care, the quality of care provided is poor. For example, patients receive the recommended treatment for their medical condition only 42% of the time
Morale is Low Among Primary Care Doctors
Given the issues we’ve discussed, it makes sense that primary care physicians have the second highest burnout rate of all physicians just behind ER physicians. Equally troubling, more than a third of primary care physicians meet clinical criteria for depression.
Burnout and depression in physicians correlates with an increase in medical errors, academic dishonesty, cynicism, and unprofessional behavior and a decrease in empathy and altruistic values. Physician burnout is also associated with poor patient experience and reduced patient adherence to treatment plans. Again, not a great recipe for high quality medical care.
Overall: There’s a Serious Shortage
The shortage of primary care doctors in the United States is expected to continue to increase.
Demand for primary care will continue to rise as the US population ages but the supply of primary care providers is not projected to keep up. Many primary care physicians are retiring, moving into other areas of medicine, or finding jobs outside of medicine, while few medical students are going into primary care. The average wait to see a primary care physician is already nearly 3 weeks and recent projections estimate a shortage of 14,900 to 35,600 primary care physicians by 2025 so the problem isn’t likely to get better soon.
If you had trouble finding a primary care doctor, or just want to have a better, more personal relationship with your doctor, our SteadyMD doctors could be exactly what you’re looking for. Browse our doctors and pick the one that’s perfect for you today.