Architects of Healthcare Reform Face Critical Shortage of Primary Care Docs

This article originally appeared in the July 12 issue of The Philadelphia Tribune

We all know the routine. You call your doctor for appointment, and -- unless you have an acute illness -- you might get one in two weeks, ten days if you're lucky.  On the day of your visit you get to the office early only to find three, four, or even five patients in the waiting room who seem to have been given the same appointment time as you.

After about 40 minutes spent flipping through old copies of Sports Illustrated your name is called and you are escorted to an exam room. Okay, you think, here we go. But you're not seeing a doctor yet. Instead, you'll sit in that tiny room staring at the jars of cotton and trays of plasma vials for another 20 minutes before the physician finally comes in. He'll spend, on average, ten minutes with you before scribbling something in your chart and rushing out to the next patient. By the time you leave, your one o'clock consultation has turned into a brief, two o'clock encounter. 

At this point it's easy to get frustrated, even angry, and many of us do. But here's a flash: it's not your physician's fault.

America is suffering from a critical shortage of primary care doctors; and with a potential 47 million uninsured people likely to get covered under President Obama's healthcare reform initiative…well, if you think things are bad now, just wait.

The U.S. Department of Health and Human Services says that as of March 31 there were 65 million people – or 21 percent of the U.S. population -- living in Health Professional Shortage Areas (HPSAs), which it defines as geographical areas with one or fewer primary doctors per 3,500 residents.  HHS says it would take 16,585 practitioners to meet a minimum requirement for adequate coverage (one practitioner per 2,000 residents). And studies indicate that by 2025 that deficit will grow to 44,000 physicians.

To make matters worse, every year fewer medical students enter general practice, choosing instead the more lucrative specialty fields. By some accounts the number of med students entering office-based primary care is at an all-time low of just seven percent.

The time it takes to see a doctor is one symptom of this problem. According to Merritt Hawkins' annual study on physician wait times for 2009, the average American waits 20 days to get an appointment with their physician. In Boston, which ranked the worst, it takes, on average, 63 days to see a doctor. The study's authors say that's because in 2006 Massachusetts passed a healthcare reform initiative that implemented near universal coverage for all of the State's uninsured. And while opponents of universal healthcare are right to call the Massachusetts scenario a harbinger of things to come under a national plan, most are unwilling to admit that what caused the problem in the first place is the competitive provision model they tend to favor. 

Dr. Steffie Woolhandler, an internist, Harvard Medical School professor and cofounder of Physicians for a National Health Care Program, says the primary care shortage is a product of the way we pay for healthcare in America.   

"The bigger issue is that the whole orientation of the system is out of whack and all the resources are concentrated in the wrong parts of the system," she says.

According to Dr. Ted Epperly, president of the American Academy of Family Physicians (AAFP), that's because the U.S. for-profit healthcare system is designed to favor expensive, procedure-based medicine over less costly patient-focused preventative care.

"Unfortunately the American healthcare system does not value what primary care does to keep people healthy," Epperly says. "We've got a back-end system that's treating all the disease that if we put the money on the front end of the system in terms of wellness and health promotion we could have prevented it in the first place." He says the reason is simple: like any other business, the healthcare market likes to sell those services that will turn the greatest profit.