The Crisis of the Primary Care Physician

There is a crisis in primary care. In the United States, the need for primary care physicians (PCPs) is continuing to rise more rapidly than the supply. According to statistics, there could be a downfall of over 35,000 primary care physicians in the year 2025. What’s more, according to new estimates from the Association of American Medical Colleges (AAMC), by the year 2030, the shortage could tally up anywhere from 40-000 to 100,000, making it harder to patients to receive the quality care that they need.

Today, over 50% of primary care physicians are experiencing symptoms of burnout and those practicing medicine have a short amount of time to spend with each patient. On average, the primary care physician spends approximately 15 minutes with each patient, which is not enough time to listen and think, thus resulting in additional tests and x-rays, frequent primary care referral, unnecessary prescriptions, and more. The root of the problem is the pressure of insurance. Insurers have paid lower rates for primary care, placing the financial burden on primary care physicians and thereby creating an increase in overhead costs. Overhead costs do not just include nurses and receptionists, but also billing and coding conundrum, malpractice and disability insurance, accounting liabilities, legal needs, health insurance for staff members, supplies, as well as rent and utilities for the practice.

As any businesses would do at this point, primary care physicians are trying to “make it up in volume” by taking on more patients per day (25 and more). However, seeing more patients during the workday means shortening the time for each visit. In fact, most face to face visits last no more than 8-10 minutes. This is not enough time to deal with simple health-related matters, let alone having to address more complex chronic illnesses. On a daily basis, the typical primary care physician looks over 40 reports, takes more than 24 phone calls, reads around 17 emails, and processes 12 prescription refills. Additionally, he or she needs time to organize and read electronic health records, as well as complete Medicare quality measure records.

At this point, patients are frustrated and rightly so. They do not have enough time to connect with their primary care physicians and they are rushed through 15 minute visits. Most even feel disrespected when they have to wait to see their physician for a longer period of time than their actual medical appointment. Yet, primary care physicians are frustrated as well. They need time to look into the patient’s medical history, time to hear their side of the story, time to examine their needs and see how to proceed with their individual situation. They need time to talk with their patients in order to explain and address any questions or concerns. Moving frantically from room to room makes is impossible to establish solid physician-patient relationships – relationships that are built on compassion and trust. In an environment where both patients and physicians do not know each other well and appointments are rushed, resources are wasted and medical errors are inevitable. By contrast, research shows that solid physician-patient relationships can result in early diagnosis of illnesses, thus allowing for better outcomes and greater patient satisfaction.

With little time for medical visits, most patients are sent to specialists. According to recent statistics, over 9% of all visits to PCPs result in an unnecessary specialist referral. At the same time, more primary care physicians are quitting and less and less medical school graduates are choosing primary care as a profession. Primary care has lost its attractiveness and value due to low job satisfaction and poor compensation. For this reason, primary care physicians are looking for ways to get out of this predicament.

Nowadays, there are a few approaches that most primary care physicians take in an attempt to overcome hurdles in providing better quality care and increasing patients’ satisfaction. For one thing, most primary care physicians are forgoing insurance billing and reducing the size of their practices. This means seeing fewer patients per day – around 500-800 as opposed to 2,500-3,000. At the same time, they do not have to delay appointments and they diminish the need for E.R. or urgent primary care. Known as direct primary care (DPC), most primary care physicians are making their services affordable and with no deductibles. What’s more, they are offering medications at wholesale prices and reducing the need for unnecessary tests and examinations. This means improved quality of care, greater satisfaction, and fewer frustrations for physicians and patients alike. For instance, primary care physicians at Catonsville-based Erickson Living retirement communities are seeing up to 400 patients. They are ensuring closer bonding among elderly individuals and a greater focus on quality care, as well as prevention of chronic illnesses. The result has been fewer hospitalizations, emergency room visits, and overall better care.

Secondly, most teaching hospitals serve as environments to train new primary care physicians in clinical rotations. Therefore, hospitals’ physical space can be restructured to implement necessary changes. Such structural changes could offer positive and pragmatic realizations. While career choices are generally made before residency, having an encouraging training experience within a curriculum could prove to be valuable. Thirdly, hospitals have a lot to gain through means of increasing primary care workforce. Extending access to newly insured patients not only serves better for the overall community but it also increases hospital revenues. This, in turn, can lead to increase in the percentage of covered individuals and cost-effective use of resources. Finally, primary care teams are strongly recommended when it comes to care for all patients. By gathering primary care practice staff, such members can contact patients who require health-related services, thereby allowing primary care physicians time to perform necessary services. Some organizations are even training medical assistants to become health coaches so that they can counsel with patients on various topics such as medication prescriptions, chronic conditions, lifestyle changes, and more. Working alongside such coaches, primary care physicians can improve both patient care and experiences.

As a primary care physician, you need to carefully look at your practice’s patterns and determine ways in which you can adjust your own workload in order to maximize efforts in quality services and make better use of technologies. This requires restructuring not just your practice, but your staff members as well. To reach this point, you need to realize that improving the patient experience is about improving services to make patients happy. It is about delivering safe, compassionate, and quality care. Failure to do so in any aspect - quality, safety or services - will result in the inability to meet patients’ needs and torn physician-patient relationships.

The overall message is quite clear. Fewer patients’ means spending more time with each individual patient by listening to them, demonstrating your caring nature, and building trust. It means fewer tests, x-rays, referrals, and prescriptions, resulting in improved diagnostics and better treatment plans. Together with affordable insurance policies, patients’ can save on healthcare and the total cost of all care can decline significantly. This also means putting more resources into better use. By reducing the patient to primary care physician ratio and offering more patient time, each visit can lead to better health and higher satisfaction. Yet, if patients want to benefit from such care, they need to educate themselves and then advocate. In a recent article published in Medical Economics, it was said that patient education followed by advocacy will be the most significant driver of change in today’s healthcare system. To force the change, both physicians and patients need to realize just how important and valuable primary care is. Taking on its rightful position, primary care in the United States is a great contributor to the American healthcare system and it can offer high quality services, lower healthcare costs, and better medical care.