A primary care shortage crisis
By Charles Joffe-Halpern
In the United States 56 million people have inadequate or no access to primary care physicians, and a majority of them have health insurance! This report issued by the American Academy of Family Physicians reveals one of the most critical public health challenges facing this country, the lack of primary care physicians. Shockingly, out of 20 industrialized countries, per capita, the United States ranks 13th in the number of physicians, far behind Greece and the Slovak Republic!
This summer a state-wide survey conducted by the Massachusetts Medical Society revealed that problems accessing care have dramatically increased. Only 50% of primary care physicians in Massachusetts are accepting new patients. If one already has a physician, even when ill, only 43% of patients who made an appointment to see their primary care physician could be seen within a week, a drop of 11% from the previous two years.
Most of these patients are eventually seen in hospital emergency rooms, frequently for non-emergency ailments. Recently, two young women shared with us they had no choice but to go to the local hospital emergency room for treatment where they incurred co-pays of $75., instead of the $15 they would have paid if their doctors were available. The cost of relying on emergency rooms for what should be treated in a doctor’s office is also passed on to insurance companies and ultimately to the cost of health insurance premiums.
Emergency room physicians are expressing their frustration at having to treat individuals for ailments that should be treated in the community. The serious medical consequences of the primary care shortage are also surfacing. Medicare patients in fair or poor health, who reside in areas where the primary care shortage is more acute, are 70% more likely to experience a preventable hospitalization, because they were not able to see a physician more quickly in the community. Emergency room physicians have also shared they are diagnosing patients, with health insurance, at later stages of serious illnesses, including cancers, because of the lack of access to needed primary physician care.
The reasons for the primary care shortage are numerous and well documented.
They include: low-reimbursement rates from Medicare and Medicaid, increasing malpractice insurance costs, and the burdensome administrative complexities of primary care practices.
In 2005 the proportion of third-year medical students going into primary care fell to 20%, as compared to 54% in 1998. It is important to note that medical school debt currently ranges between $100,000-$200,000 (4.5 times as high as 1984). The median yearly income for primary care physicians is now $162,000 as compared to $297,000 for specialists.
Most students enter medical school with the intention of pursuing primary care, wanting to practice medicine that includes having an impact on people’s lives, purposeful relationships, and the challenge of diagnosis and treatment. By the time students finish school though, burdened with medical school debt, and facing a relatively lower income with longer hours and more stressful work conditions, it is understandable why many choose to pursue specialty care. According to the Association of American Medical Colleges, more than 70% of young physicians say that having family and personal time is an important factor in a desirable practice.
To date, with the implementation of health reform in Massachusetts, over 175,000 previously uninsured individuals now have health coverage; indeed this is good news. Here in north Berkshire County though, we are already referring residents 28 miles away to find primary care physicians taking new patients.
In the United States there is now increased political will to expand health coverage to the uninsured, with many states proposing healthcare expansions that have bipartisan support. But, nationally, if the stresses causing physicians to flee primary care are not addressed, these health care expansions will be more seriously challenged. We are already beginning to feel that here in Massachusetts, and other states will learn from our experience.
Charles Joffe-Halpern is the executive director of Ecu-Heath Care and the president of the Board of Directors of Health Care for All in Boston. He can be contacted at cjoffehalpern@nbhealth.org. This article first appeared in The North Adams Transcript.
