Transforming Primary Care: Why USA Lags Behind Other Nations

Primary Care still lags behind other specialties in U.S. medicine, but why?

Is it just a matter of people seeking more highly paid specialties? Why is the USA behind other countries regarding this specialty? The Annals of Family Medicine said earlier this year that an additional 52,000 Primary Care Physicians are needed by 2025, a little more than 10 years away.

The UMHS Endeavour explores reasons why there are so few Primary Care physicians, based on recent press reports, and what this means for the public and students at American and Caribbean medical schools. This is the first installment in a new UMHS Endeavour series, “Transforming Primary Care”.

Only 1 in 6 Med School Grads Choose Primary Care

An article on TheHill.com website this week included alarming statistics about Primary Care in the USA.

Following are key points of the article:

• “Unlike other wealthy countries, the United States has a low ratio of Primary Care physicians relative to medical specialists."
• “Currently, only one in three physicians practice Primary Care, and only one in six medical graduates chooses Primary Care."
• “When you consider that primary care visits account for 55 percent of the 1 billion physician office visits each year, and that the Patient Protection and Affordable Care Act (ACA) could generate an additional 25 million primary care visit annually, one begins to see an already stressed system being pushed to the brink.”
• “One way to measure the adequacy of Primary Care access is by availability of obtaining a doctor's appointment when ill. Although we traditionally have criticized other countries for their long queues in receiving care, there is emerging evidence that long waits for primary care is becoming the norm in the U.S. According to a 2013 study by the Commonwealth Fund, 26 percent of 2,000 Americans surveyed said they waited six days or more for a doctor's appointment when they were sick or needed care. This is just barely better than Canada (33 percent) and much worse than Britain (16 percent).”

Are Primary Care Physicians Becoming ‘Extinct’?

An article on KevinMD.Com back in February 2014 had sobering things to say about the topic.

“Primary care physicians (PCPs) are becoming extinct,” the article said. “Not many medical students choose primary care as their career path. Older PCPs are retiring early. Many others are closing their practices or seeking employment at the local hospital. And there has always been a shortage of primary care physicians in rural and urban poor areas. Today only 30% of all physicians practice primary care (compared to about 70% in most other developed countries and about 70% in the United States fifty years ago) and this percentage is shrinking at a steady rate.”

View from Matthew Mintz, M.D. at Primary Care Progress

Matthew Mintz, M.D. explains, on the website PrimaryCareProgress.org, in the article “Why Medical Students Aren’t Choosing Primary Care (And Why They Should),” why he believes fewer med students choose Primary Care.

“In my opinion, it’s because they don’t like what they see when they are exposed to outpatient primary care during medical school,” he writes. “Their Primary Care preceptor is frustrated with treating complex medical conditions in 15-minute time slots. Their Primary Care faculty waste time on the phone with insurance companies, exasperated because they are unable to get their patients the treatment they need. Frustrated patients sit in waiting rooms for 30 minutes or more only to get rushed through a 10-minute visit with their doctor, who is constantly behind schedule.”

Dr. Mintz continues, “Students sign up for medical school to have strong, meaningful relationships with patients. In fact, primary care should be the best place for these experiences. However, most students find in medical school that primary care is not what they had envisioned. Combine this with overwhelming debt and the substantially higher salaries their peers will earn, and it should be no surprise that students don’t choose Primary Care. It’s not primarily the salary or student loans; today’s students simply don’t like the current practice of Primary Care.

“The good news for students interested in Primary Care is that the practice of Primary Care is changing. It has to because the current health care system is broken, particularly in the Primary Care setting.”

The UMHS Endeavour will examine the goals and proposed solutions of the grassroots organization Primary Care Progress in a future installment of “Transforming Primary Care.”

(Top photo) PRIMARY CARE SHORTAGE IN USA: Only 1 in 6 med school grads choose Primary Care, a recent news article says. Photo: Deposit Photos

About UMHS:

Built in the tradition of the best US universities, the University of Medicine and Health Sciences focuses on individual student attention, maintaining small class sizes and recruiting high-quality faculty. We call this unique approach, “personalized medical education,” and it’s what has led to our unprecedented 96% student retention rate, and outstanding residency placements across the US and Canada. UMHS is challenging everything you thought you knew about Caribbean medical schools.

Video from Primary Care Progress