By LEE BOWMAN
Scripps Howard News Service
Why is the doctor "out" for millions of Americans?
Family doctors and experts say there are not enough primary care doctors for two main reasons: time and money.
Despite widespread calls for each American to have a primary care doctor, neither government programs like Medicare and Medicaid nor private insurance generally pays doctors for quarterbacking patient care, or pay for visits addressing multiple medical issues.
Family doctors, pediatricians and general practitioners end up being paid less, because the reimbursement system assumes what they do is less complex than specialists.
With an aging population of patients, at least half with one or more chronic conditions and a growing list of recommended preventive care, good primary care takes a lot of time, both from the doctor and support staff.
Yet primary care doctors often earn $150,000 or less a year, about half as much as specialists.
Not surprisingly, only about 7 percent of medical students in a recent survey said they were pursuing primary care, especially when they graduate with an average debt of $140,000.
Physician dissatisfaction with primary care is high. The Physicians Foundation found that most family docs are unhappy with their long hours, high patient loads and relatively low pay. Few would recommend their field to new doctors, and only 40 percent would choose their career path again if they could do it over.
"It's the tyranny of the 15-minute visit. You come into your practice in the morning and you see you have 12 to 15 15-minute visits in the morning and another 12 to 15 15-minute visits in the afternoon, and you know you can't do it all in 15 minutes,'' said Dr. Thomas Bodenheimer, a primary care expert at the University of California-San Francisco.
The impacts are widespread:
- Many busy offices are trying to keep up with patient demand by hiring physician assistants or nurse practitioners to handle appointments.
- Some, frustrated by no-shows and unrealistic scheduling, have abandoned appointments entirely, just letting patients walk in first come, first served.
- Family medicine is aging. A third of family physicians are 55 and older, and many are winding down their practices.
- The Physicians Foundation survey found that 49 percent of primary care doctors said they expect to reduce the number of patients they see, or stop practicing entirely, within the next three years.
- Family medicine is feminizing. The majority of new primary care doctors are women -- a third of the total and soon to be two thirds. Female doctors are more likely to seek limited work hours or part-time practices to accommodate their children.
- Many younger doctors, male and female, reject a lifestyle that requires working 60 to 80 hours a week and being on-call.
"There's a lot of demoralized people in the trenches, and a lot of young doctors are wondering if they want to go into primary care or stay in it,'' said Dr. Ted Epperly, president of the American Academy of Family Physicians. "A lot of them are choosing more lucrative, less demanding paths in and out of medicine."
