Primary care, including family practice (general practice), internists, OB-GYNS, pediatricians, geriatricians and others are in the midst of the perfect storm - and that may spell problems for some patients.
Primary care reimbursements are lower than any specialty physician reimbursements, and that has made primary care less desirable for many young doctors as they complete their studies. Add that to the fact that the baby boomer physicians are retiring in huge numbers, and that some doctors, disgusted and frustrated by all the changes to the healthcare system, are retiring early - and what you have is a decreasing number of primary care physicians at the very point in time when they are now the gatekeepers to all insured healthcare.
That means at least two problems for patients:
- First, that it is becoming increasingly difficult to find a primary care provider (PCP) for those who don't already have one. Add to that the fact that beginning January 1, 2014, 30 million Americans who have been uninsured to this point will have purchased insurance to fulfill the individual mandate - and can begin making appointments with that dwindling number of PCPs. More patients and fewer doctors will mean even more difficulty getting an appointment, and the potential impossibility of finding a new primary care doctor if you need one.
- Second, that the doctors who are providing care will be stretched for time even more than ever before. Too many patients in too little time means that our individual time will be even more limited than it is now, and that doctors will have even less time for coordinating our care. That can lead to more mistakes, like drug conflicts, or misdiagnosis.
One solution to the shortage of primary care doctors is the increasing numbers of mid-level providers (nurse practitioners and physician assistants) who are being found in larger numbers in primary care practices. They generally do an excellent job of standard care that does not require specialized knowledge or expertise. That frees up doctors to work with the patients who present more difficult challenges.
Smart patients know that they must be enrolled with a primary care practice (doctor or mid-level provider) before the end of 2013. Even if you aren't sick, plan to get a check up, or be seen for a preventive screening test to be sure you are on your primary care practice's roster of patients.
If you are having trouble identifying a primary care practice that will accept your insurance, it may be worthwhile to find a patient advocate who can help you.