You know the scenario all too well. You show up for your doctor's appointment on time, and if you were smart, you scheduled it for either 8:00am or 1:00pm, hoping for less wait time. But as the sign at the check-in counter suggests, after 30 minutes you step up to the desk to remind the receptionist that you are still waiting. According to Merritt-Hawkins and Associates, a consulting firm that specializes in recruiting physicians, since 2004 the wait time to get an appointment has increased by more than a week to 20.5 days. In Boston, it takes 49.6 days on average to see a doctor; in Atlanta it takes 11.2. In 2011, the The NY Times reports an average wait of 23 minutes to see the doctor, with neurosurgeons having the longest wait times (30 minutes) and optometrists the shortest (17 minutes).
The Patient Protection and Affordable Care Act will expand health insurance coverage and access to an estimated 32 million United States citizens by 2014. Expanded coverage is predicted to increase the number of annual primary care visits between 15.07 million and 24.26 million by 2019. This means that between 4,307 and 6,940 additional primary care physicians will be needed to accommodate this increase. But right now, in the U.S., according to the American Medical Association, we have a shortage of 15,230 doctors, which is expected to grow to an astonishing 63,000 by 2015. Those figures do not take into consideration the effects of the ACA.
The number of U.S. medical school students going into primary care has dropped 51.8% since 1997, according to the American Academy of Family Physicians (AAFP). The AAFP predicts a shortage of 40,000 family physicians by 2020, when demand is expected to spike due to the increase of baby boomers who will reach the age of 65 and require increased medical care.
It takes 10 - 15 years to train a doctor, at an annual cost of $50K per year. The average debt for a doctor coming out of medical school is $162K. While orthopedists and radiologists typically make $315K per year, the average starting salary for a primary care doctor is $170,000, with , minus $2100 per month for 10 years to pay off student loans.
Longer days, lower pay, less prestige and more administrative headaches have turned doctors away in droves from family medicine. Internists provide a large portion of care for older and chronically ill patients, who require more time, paperwork, and followup than other patients. In 2012, 9.2 minutes of every 15 minute visit are spent addressing the patients' resource needs, like care at home, transportation to the doctor's office, and money for prescriptions.
With the expected increase of primary care visits due to the aging baby boomer population and the addition of 47 million newly insured thanks to the Affordable Care Act, primary care physician demand will sharply escalate. Although the primary care doctor has been the gatekeeper in keeping people out of emergency rooms and controlling health care costs, finding a doctor will become increasingly difficult and more people will turn to crowded emergency rooms for their care. Between 1990 and 2009, 27% of emergency rooms in metropolitan areas closed. (Note: my daughter's medical school class at Emory University lobbied the Georgia state legislature to keep Grady Hospital in Atlanta from closing due to bankruptcy in 2008.) The lack of ER availability (which isn't a good solution for primary care needs), coupled with the shortage of doctors means less quality care for many Americans, especially those in poor urban and rural areas.
What is being done to address the shortage of doctors and the increase in need for patient care? Hospital administrators and ER physicians are acutely aware of the coming scarcity, and have taken measures to add non-urgent care clinics to their departments and more physician assistants and nurse practitioners, some of whom can dispense certain prescriptions and recommend specialists, to their staff. Medical schools are looking at providing more 'cognitive' specialties by adding residencies in gerontology and geriatrics. (My son is a first-year resident in Geriatrics at the University of Virginia).
There is also much that Congress can do to address the doctor shortage. Rep. Allyson Schwartz (D-Penn.) and Rep. Aaron Schock (R-Ill.) are co-sponsoring legislation that would eliminate the 1997 Balanced Budget Act residency cap, a cap that limits the amount Medicare can contribute to residency programs. “It is an expense that is necessary,” Schwartz said in an interview. “We’ve seen an increase in the number of doctors that medical schools are training in this country. There’s not an adequate number of residencies to handle that increase.”
The Affordable Care Act Prevention and Public Health Fund allocates $500 million dollars to support the training and development of primary care professionals who frequently deliver preventive services to patients, and supports training of public health providers to advance preventive medicine, health promotion and disease prevention, and improve the access and quality of health services in medically under-served communities. This is a start in the long journey to bringing healthcare in America to a standard that is acceptable for all.
[A Note From The Diarist: As the ex-wife of a doctor, and the mother of two doctors, I have spent over 30 years supporting their training and practice; financially, physically, and emotionally. I worked as a programmer while supporting my ex-husband through medical school and residency, spending many lonely hours raising my three kids as though I were a single mom, and now I spend many hours counseling my son and daughter, who are in their residencies, through their ups and downs. I have participated in the private, emotional, and often scary part of becoming a doctor that most people never see: countless hours of studying and tests, peer pressure, the constant questioning of performance, the self-doubt and worry over patients, sleepless days and nights, interrupted meals, and the ever-present question: will I make it to the next step? Medicine is one of the few careers where you can invest years and years of training, only to be told you didn't make it to the next level. I have watched two generations of doctors grow and change, and with it the changes in medical practice and doctors' quality of life.]