Just when you think the primary care shortage can’t get any worse.
Not only are there not enough primary care access to serve the almost 50 million uninsured Americans, recent numbers also show that out of 270,000 primary care doctors, almost 5,000 of them are older than the age of 75.
They simply can’t retire, mainly because of an inability to find a young doctor to take their place within the community. And as we know, not only is there a wide salary disparity, younger doctors are unwilling to taken on the lifestyle that primary care demands.
Indeed, as this 72-year old physician says, “They’re not willing to be on call 24 hours a day . . . I’m a dinosaur. There’s not people willing to do that anymore.”
So this forces doctors to work well into their 80s. And when they do eventually retire, many patients will be left in a lurch, as many areas are already in dire need of primary care doctors, even before these elderly physicians hang up their stethoscopes.
Related posts:
- Are patients who enter hospice care really abandoned by their primary care doctors?
- Health reform ignores primary care doctors at its own peril
- Where’s the money to better pay primary care doctors going to come from?
- Why this doctor left primary care
- Medical students want to become primary care doctors, until reality hits
- Ezra Klein on the primary care shortage
- Foreign doctors and primary care
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Primary care is not alone. The average of a surgeon in the US is now 55. Retirement comes much sooner for surgeons due loss of technical skills, so this is a much worse situation than in primary care. The loss of work ethic in younger surgeons is similar: they want big bucks for less work so there will be many underserved areas.
Excessive paperwork, less autonomy, poor reimbursement has contributed to decrease in the number of Primary Care Physicians. Also advent of the hospitalist system will channel most primary care graduates to become one, as it has better lifestyle, more pay, less working hours. So unless there is a DRAMATIC improvement in reimbursement of outpatient primary care practices, the shortage is going to get only worse from here.
Nobody is “forced” to work into their 80s, or even younger. If they need the money or enjoy the work, they can work. Otherwise retire. No one is so special that that can’t be replaced. The older docs should do what is in their best interests.
We could argue all day about the reasons “50 million Americans” are uninsured – and whether or not the government is responsible for picking up that slack.
As for this statement re: young guns and primary care: “They’re not willing to be on-call 24 hours a day.”
Acutally, it’s not entirely true. A lot of younguns still come out with stars in their eyes. They just have then gouged out.
As a Locums, I’ve covered “24/7″ for a number of established/older doctors in these smaller, rural (often empoverished) communities who are in the boats they’re in now because they spent YEARS treating younger ones like dirt . . . dumping and cherry-picking what they did . . . still operating under the assumption that poo-poo & “scut” trickles down. When they recruit “fresh meat”, they pile on the abuse.
Then, they do not understand why the disenchanted young guns bolt when they can.
There’s a whole lot more technology and liability for the younger folks these days. The days of the “one-doctor-does-it-all” are over (and I mourn those days, because it’s what I originally aspired to).
Moreover, over the last 15-20 years, a whole lot of small town and rural hospitals have taken a whole lot for granted when it comes to recruting and retaining doctors.
It’s coming back to bite. About time.
Retire when you want to and are able to. Young guys want as much as they can get. I can’t blame them. The shroud of mystery has been lifted and they know that money is being made and they just want their piece of the action. The breakdown of the doctor/patient driven healthcare model has revealed us to be highly trained vocational workers obliged to the patient, hospital, insurance companies and government. Ultimately, we as physicians, should do what is in our best interests. No one is watching out for our needs and families’ best interests. The patients that we agree to treat are entitled to our skills, honesty and best efforts to make them well. That’s it. I know of no other profession that comes close to physicians in trying to fulfill these goals. We have nothing to apologize for. Hospitals will continue to whore our services, insurance companies will continue to collect premiums and deny claims and the government just wants citizens to “be seen”, control cost and to get re-elected. Patients will often feel that they are entitled to your services for free and try to, often successfully, not pay you for services. And for this, anything not rising to the level of medical perfection becomes fodder for our wonderful tort system to feed itself. The only ethical cog in this machine is us. Do your best, protect yourself and fight like hell those that would injure us. There is no benefit in being a lamb and taking one for the team. Even when the “gloves come off” we still know that we matter and that we are civilized and bring more good into this world by our actions than most anyone else. Not a bad gig. Such a shame that it may be coming to an end.
Retired at 36! Five years ago. LIfe could not be better.
My God, Paul, I was just moved to say, AMEN!
FormerMD – what is your secret? Did you move to Panama?
There is no shortage of primary care doctors. If there were a shortage, their incomes would have gone up.
I agree with Supremacy Claus. If the demand for primary care was that great, the price(income) should have gone up instead of down. The American public sees no value in primary care, otherwise they would be willing to pay more. You guys in primary care have let this happen by giving in to government payers and insurance companies and have no one to blame but yourselves. Quit bitching and do something about it. I would suggest dropping out of Medicare for starters
Sorry, supremacy, but you are wrong.
In a third party payor system, supply and demand economics do not apply.
Corrolary: if health insurance companies are competing with each other for members, how come their rates do not go down? Or, if radiology suites are competing with each other for patients, how come the cost of an MRI does not go down?
I wish it were simple, but it ain’t.
Fam: Assume you are totally correct, and market force does not operate.
Are times to first appointment lengthening? How about times between follow up appointments?
Supremacy: I am not sure what point you are trying to make, but, yes, times to first appointment and follow ups are increasing.
RE: “Corrolary:”
Corollary.
“The American public sees no value in primary care, otherwise they would be willing to pay more.”
I pay for my insurance premiums and in return, the insurance company pays for part of my medical care when I need it. The doctors in my network have agreed to accept payment under my plan. So by paying more, do you mean that I slip the doctor $50 during the exam…or do you mean that I should pay more than the billed amount?
It is a crime to use my insurance. Perhaps I should go “naked” and file bankruptcy when the bills get to much.
I pay the same for a primary care visit as I do for a specialist visit. The PCP doesn’t have time to evaluate my health and I see little value in establishing a relationship with one. I have good relationships with specialists for the same price….
Primary care physicians CAN increase their income due to the shortage, if they go the MDVIP route. That is the only way for them to get on the ‘open’ market, away from insurance company valuations of them. With 600 patients an MDVIP doc brings in $600,000, per year, plus what they get from insurances. Not a bad deal. You just have to be willing to make the switch to see how people may in fact value you. Even if you had ‘only’ 300 patients, you will still be doing pretty well.
Supremacy Clause,
I think David is right on – VIP medicine is the true capitalist response to the primary care shortage. And yes appt wait list times are going up all over where I live. Why don’t more docs go into VIP medicine? They certainly can, but most PCP’s do not want to give up taking care of established patients – often on Medicare and Medicaid. To let go of 3/4 of your patients for those that are well heeled would take thick skin. I don’t think PCP’s are that capitalistic.
But I think it is a point worth making: If people want the market forces to work, VIP medicine is the result and should be more common.
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