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Shortage of Primary Care Physicians

Shortage of Primary Care Physicians

America is experiencing a shortage of primary care physicians. You may have experienced this in delays in access, long wait times, rushed appointments, physician sentiment concerning their practices, and complaints from the general public that they find it difficult to find a doctor.

Research conducted in September 2019 by Public Opinion Strategies indicated that 35% of respondents had trouble finding a doctor over the preceding three years and, according to a 2017 study by Merritt Hawkins, the national average cumulative wait time to schedule a new patient-physician appointment is twenty-four days—the longest it has been since the survey began in 2004.

The rapid expansion of physician extenders or midlevel providers across the country is further evidence of a demand for medical services that substantially exceeds the capacity of our currently licensed physician workforce. Nonphysician providers are typically trained and licensed as physician assistants and nurse practitioners who provide care under the supervision of physicians.

There are currently over 325,000 nurse practitioners (NPs) and more than 115,000 Certified Physician Assistants (PAs) practicing in the United States. Of these, about 27% of PAs and 75% of NPs are providing primary care services. That equates to about 275,000 midlevel providers, which is nearly as many as the 299,000 practicing primary care physicians.

Prior to the rise of COVID-19, the magnitude of the primary care physician shortage had been estimated at 55,000 physicians nationwide by 2033. In addition to the recent effect that the pandemic has had on disruption of primary care, the main drivers of this shortage are an aging population, accelerated physician retirement, and a low percentage of new physicians choosing to specialize in primary care.

Demographics

The US population aged sixty-five and older is projected to grow by 45.1% by the year 2033. As our elderly population continues to grow, the demand for general and specialty physician care is also expected to increase dramatically. It is self-apparent that the older we get, the more likely we are to require healthcare services. Older adults use far more healthcare services than younger adults and children.

The diagnosis of serious or chronic health problems increases with age and is directly associated with higher per capita healthcare costs. Specifically, people over the age of fifty-five make up 29% of the population but account for 56% of all health spending. The declining health and increasing healthcare costs that occur with age increase the workload for physicians practicing primary care and also for specialist physicians. To compound matters, at the same time that patients are aging and requiring more care, their physicians are aging and may be less able to deliver the same volume of care.

Physician Retirement

The baby boomers are retiring. Baby boomer physicians are now retiring at an accelerated rate. Greater than 40% of currently active physicians will be at traditional retirement age of sixty-five or older within the next decade, including myself, at the same time that baby boomer patients are requiring more care. Additionally, physician surveys indicate that 31.6% of practicing primary care physicians are currently experiencing anxiety, withdrawal, and burnout, which is likely to result in significantly earlier retirement than has occurred historically.

There seems to also be an ongoing effect of COVID-19 on physician practice patterns and their attitudes about retirement. The added stresses and financial concerns that have occurred with the COVID-19 pandemic have led some primary care physicians to early retirement—yet another unexpected consequence of the pandemic. A survey of primary care physicians conducted in September 2020 indicated that 19% of respondents experienced physicians in their practice retiring or planning to retire due directly to the consequences of the COVID-19 pandemic.

Fewer Physicians Choosing Primary Care

At the same time that older physicians are retiring (some earlier than expected), new physicians are not choosing primary care. Physicians graduating from medical school have a lot of options when it comes to choosing an area of medicine to pursue as their career. Their interests, lifestyles, work-life balance, and income are greatly impacted by this choice.

The number and percentage of medical school graduates who are pursuing careers in primary care have dropped dramatically over the past thirty years. From 1997 to 2005, the number of US medical graduates entering family medicine residencies dropped by 50%, and according to the 2019 Residency Match Report, only 41% of available internal medicine residency positions were filled by MD students graduating from US medical schools. Similar trends were seen in family medicine and pediatrics. The percentage of active physicians practicing primary care in the US has decreased from 50% in 1961 to less than 32% in 2019.

The financial ramifications of choosing a career in primary care are a significant factor in the declining interest in primary care careers. There is a substantial compensation gap between primary care and specialty physicians. The highest earning specialist physicians average twice the annual salary of primary care physicians. This, in conjunction with the significantly increasing cost of medical education, has made primary care relatively unattractive from a financial standpoint.

Physicians simply do not wish to accept lower salaries and income when faced with a quarter of a million dollars in medical school debt.