Fewer Americans Have Primary Care Doctors: Alternatives to Keep PCPs Working

Fewer Americans rely on a primary care physician (PCP) for their medical care than in past years, particularly younger individuals, raising concerns among health experts.

“Primary care is the keystone in a quality healthcare ecosystem,” said Daniel Devine, MD, dual-board certified internist and geriatrician and co-founder of Devine Concierge Medicine in Wayne, Pennsylvania. “Primary care serves as the quarterback on a healthcare team, ensuring patients’ successful navigation of the healthcare system. Without a primary care physician, who is organizing and implementing patient care plans?”

Additionally, “A PCP lowers the healthcare costs of an average patient by 30 percent,” said Tom Koulopoulos, chairman and founder of Delphi Group, a Boston-based think tank that advises Fortune 500 companies and governments on future trends.

“Primary care physicians focus on disease prevention, obtain vital screening tests, expedite workups, and engage patients to avoid unnecessary emergency room visits or readmissions to the hospital,” Devine said.

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What has changed in healthcare delivery? 

A number of studies show that fewer patients, especially younger patients, are choosing care from primary care doctors:

  • A research letter published in JAMA Internal Medicine in December 2019 compared differences in primary care from 2002 to 2015. The researchers found those with a source for primary care declined from 77 percent to 75 percent, with significant decreases among people in their 30s, 40s and 50s and for those without chronic conditions.

  • A different study, reported in Annals of Internal Medicine in 2020, studied primary care visit trends among people insured through a national commercial insurer and found they made 24.2 percent fewer primary care visits in 2016 than in 2008.

  • A 2019 study from the Kaiser Family Foundation indicated 45 percent of adults age 18 to 29 years did not have a primary care physician, and 26 percent of all adults do not have one.

  • A Rand Corp. study reported in 2016 many younger adults were using retail clinics, with 43 percent of visits made by people age 18 to 44 years.

  • The retail healthcare market has continued its popularity in the last few years. Walmart announced in June 2020 plans for expanding its Walmart Health clinics, which offer primary care as well urgent care. And in July 2020, Walgreens announced that it would open 500 to 700 full-service, physician-led clinics in partnership with VillageMD.

    Millennials are also drawn to telemedicine and online connections.

    “They regard face-to-face as an unnecessary inconvenience in any case where online can be a substitute,” Koulopoulos said. “Millennials are actually moving healthcare in the right direction by shifting a large portion of healthcare to an online diagnosis and delivery model to the cloud. Telemedicine, wearables and predictive analytics will make it possible to deal with not just the millennial issues but the general lack of bandwidth faced by PCPs who are increasingly dealing with panels of 2,000 or more patients with increasingly more complex conditions as society ages.”

    Alternatives for primary care physicians

    In addition to the changes in reliance on primary care providers, the COVID-19 pandemic affected finances of primary care practices. A study in the September 2020 issue of Health Affairs indicated between February and May 2020, primary care offices lost $15.1 billion. Some may not survive the pandemic. Higher overhead costs, fewer patients able to be seen in the same amount of time and an aging physician workforce ready to retire could lead to a decrease in primary care physicians.

    A survey by Merritt Hawkins in collaboration with The Physicians Foundation released in 2020, learned 14 percent of physicians plan to change practice settings as a result of COVID-19, and 18 percent plan to retire, temporarily close their practices or stop providing patient care.

    As fewer people seek primary care, it could lead to a need for fewer primary care doctors. There are alternatives to traditional practices.

    Devine has found his niche as a primary care physician with a concierge practice. He makes house calls, and supplements them with telehealth services.

    “For this reason, we are seeing tremendous patient interest in our model of primary care,” Devine said. “High quality primary care saves both health systems and patients time and money.”

    Another alternative is to transition to locums from a full-time primary care practice. Staff Care consistently has hundreds of short-term openings for primary care physicians. Benefits include a housing allowance, medical liability insurance and competitive pay.

    Locum tenens provides opportunities to practice medicine without the hassles of running a practice, managing staff and other stressors.

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