The Primary Care Doctor Shortage

How will you get basic healthcare with the growing shortage of primary care doctors in America? One way is getting to know your local nurse practitioner.

The United States faces a growing shortage of primary care physicians, although not everywhere. In many areas, patients are likely to shift towards using retail clinics and seeing nurse practitioners and physician assistants, changes that will help but may not completely make up for the lack of primary care doctors.

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A looming shortage

Across the nation, physicians serve an aging, increasingly sick population, and many are working fewer hours or retiring outright. Putting those two trends together, one report by the American Association of Medical Colleges estimates America may be short by 21,400 to 55,200 primary care doctors in 2033.

Patients are already feeling a squeeze, according to poll commissioned by the group. Thirty-five percent of respondents said they had trouble finding a doctor (not necessarily in primary care), up from 25 percent four years earlier. Meanwhile, because of lower pay compared to some specialties, jobs in internal medicine, family medicine, and pediatrics have had trouble attracting candidates from U.S. medical schools.

Note that these figures don’t include the effect of the COVID-19 pandemic, which may have accelerated retirements.

Location, location, location

National figures, however, don’t reveal big variations by location. The Northeast — especially New York, Vermont, Connecticut, and Rhode Island — is flush with doctors of all kinds and probably will continue to be. The South and West, on the other hand, will have fewer physicians per person, and shortages could become severe in pockets of underserved states, notably Mississippi, New Mexico, and Louisiana, according to a study projecting from current trends.

Communities with a large elderly population are also more vulnerable. In California, for example, the elderly population is expected to grow by about 150 percent over the next decade, much faster than the rest of the country, while a third of all active physicians in the state are heading towards retirement, slightly more than the national figure.

Within state borders, your access to a doctor is already much better in a city or suburb. The patient-to-primary care physician ratio in rural areas is only 39.8 physicians per 100,000 people, compared to 53.3 physicians per 100,000 in urban areas.

What you can do

You may need to get used to seeing other kinds of medical professionals, perhaps including a doctor of osteopathy. In 2019, about 57 percent of DOs specialized in primary care, compared with 30 percent of MDs. Osteopathic physicians receive similar training as MDs and learn hands-on body manipulation techniques. Nurse practitioners and physician assistants can also answer many questions.

You can also:

• Consider trying urgent care centers to check out a cold, rash, or sprain. Make use of mobile units that come to your workplace or neighborhood.
• Monitor specific vitals — your blood pressure or blood sugar — at home with over-the-counter devices.
• Take responsibility and follow medical advice for medication, exercise, diet, and stress relief.

How health organizations and policymakers can bring primary care to more people

1. Expand insurance coverage. More than 10 percent of the non-elderly population is uninsured. Changes in Medicaid eligibility and other changes could help more people afford to see a primary care physician.
2. Make primary care more convenient, so it is available on evenings, nights, and weekends.
3. Encourage patients to build relationships with physician assistants and nurse practitioners.
4. Make sure there is sufficient care available for people who have Medicare, Medicaid, and other public programs that some doctor practices see as paying too little for their time.
5. Use medical practitioner’s time more efficiently. From 20 to 30 percent of a physician’s time is absorbed by clinical documentation, electronic medical record inputs, and other compliance-related work.

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