Looming Shortage of Primary Care Physicians Questionable

The coronavirus pandemic has been a particular challenge for America’s frontline health providers — primary care physicians. This brings up the age-old question: Are we facing a shortage of primary care physicians? Some projections seem to support this view, although there are reputable sources that say these dire warnings are no longer valid.

Among those predicting a PCP shortage is the Association of American Medical Colleges. The AAMC estimates that the U.S. could face a shortfall of 21,000 to 55,000 primary care physicians by the year 2023. If that’s the case, why are visits to primary care physicians continuing to fall? Two recently published studies help explain this apparent contradiction.

One of the studies, published in the Annals of Internal Medicine, points to the simple fact that patients have become more adept at going online for healthcare information that can address their non-acute needs. Plus, partly due to the coronavirus pandemic, patients have become more comfortable with telemedicine visits that can replace a trip to the doctor.

Another reason for the decline in PCP visits is that more patients are choosing other venues for healthcare services, replacing PCP visits with visits to specialists, retail clinics and urgent care centers. Dr. Ishani Ganguli, this study’s lead author, emphasizes that these alternatives cannot replace the value of having a long-term relationship with a primary care physician.

However, the main reason why PCP visits have dropped off, says Dr. Ganguli, is directly tied to rising out-of-pocket costs. With the aim of discouraging “unnecessary” visits, commercial health insurers have been steadily increasing the patient’s share of the PCP visit by raising deductibles and co-pays.

The other study, which appears in JAMA Internal Medicine, supports this view, pointing out that oftentimes “the deductible is so high that the insurance is essentially good for catastrophic events only.” The disturbing consequence, say the authors, is that more people with chronic conditions are delaying or skipping visits to a primary care doctor for clinically indicated preventive services or non-acute treatment. This has a direct adverse effect on the timely diagnosis and treatment of conditions like high blood pressure, diabetes, hypercholesterolemia, and chronic kidney, lung, and liver disease, as well as the early detection of a long list of cancers. In short, there are multiple reasons behind the drop in PCP visits. “

It’s time to stop panicking about a looming ‘shortage’,” according to the Advisory Board at the Harvard Business Review. “Rather, the real shortage is one of courage to disrupt the way things have been done for decades. Taken altogether, the 190,000 PCPs expected to be working in 2025 should be more than sufficient to meet America’s primary care needs.”

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