Disappearing Doctors

What accounts for the dramatic decline in the number of doctors opting to be primary-care physicians? Simple economics, mostly. "They're not dumb," says Candice Chen,...
by | August 31, 2009

What accounts for the dramatic decline in the number of doctors opting to be primary-care physicians? Simple economics, mostly. "They're not dumb," says Candice Chen, a professor of pediatrics and health policy at George Washington University. "They do notice that if you're a specialist, you'll make four to five times more than a primary-care doctor."

One of the problems is distorted Medicare reimbursement rates that pay more to specialists. In addition, many of the things that primary-care doctors do, such as giving advice and responding to patient e-mails, are not usually compensated at all. Medical schools and residency programs also have tilted toward specialists in recent years.

The result is that today's primary-care physicians tend to be aging baby boomers who feel overworked and underpaid--and are talking about retirement. With universal health care on the agenda in Washington, there are serious questions as to whether the existing primary-care network can handle expanded access to health insurance. After Massachusetts implemented near- universal health insurance a few years ago, wait times for primary-care doctors increased. Today, more than one-third of primary-care doctors in the state report that they aren't accepting new patients.

This is significant, since research links an adequate supply of primary-care doctors to better health outcomes and lower health costs. Efforts to coordinate care, such as the medical-home model, depend on primary-care providers.

Even if reimbursement rates change and medical education finds a way to encourage young doctors to turn to primary care, these solutions will take years to have a significant effect on the supply of primary-care doctors in the workforce. The answer may lie in developing nurse practitioners and physician assistants who can take up some of the slack--working in coordination with primary-care practices. And, once again, it may be up to the states to find a way to make this solution work.

Josh Goodman
Josh Goodman | Former Staff Writer | mailbox@governing.com