Shortage of doctors leaves patients in primary care predicament

Marcus Pickett

With nearly any type of health care resource, there often isn't enough to go around. Yet primary care is among the scarcest of all health care resources. And that could be pushing more patients into emergency rooms, even if they don't need to be there.

Barriers to primary care

The uninsured aren't the only ones heading to the ER for non-emergencies. Patients with insurance are filling emergency rooms as well because they've been unable to access primary care, according to a recent University of Colorado School of Medicine study.

According to the study, people who face at least one barrier to primary care are more likely to seek ER care. And those barriers, according to the study, have doubled over the past decade. They include limited physician office hours, wait times for appointments, difficulty in getting in touch with a primary care physician's office to make an appointment, and transportation issues.

In other words, patients who have to wait a long time to get an appointment that they can't get off of work for anyway likely will just head to the ER.

Why so few primary care doctors?

According to the Kaiser Family Foundation, more than half of all patient visits in the United States are for primary care, but less than 40 percent of all physicians are primary care doctors. With 16 million more people projected to receive health coverage by 2014 under the federal health insurance mandate, the problem stands to get much worse without aggressive and effective action.

It's not as though soon-to-be doctors have suddenly become averse to the type of personalized, continuous care that primary care physicians deliver. Indeed, for many, primary care is the top preference. Yet when the time comes to choose a specialty, new doctors saddled with medical school debt opt for a more lucrative career path. The Kaiser Family Foundation points out that "wide income disparities" exist between family physicians, whose annual income averages $173,000, and those practicing specialties like radiology ($391,000) and cardiology ($419,000).

Possible solutions

This shortage of primary care physicians is costing the health care system. Emergency room care is expensive. Moreover, regular primary care can lead to early detection of symptoms -- which, in turn, leads to earlier diagnosis and more effective (and often less expensive) treatment.

As part of the health care reform law passed in 2010, $250 million will be spent to boost primary care services, according to HealthReform.gov. The money will go toward:

  • Creating additional primary care residency slots.
  • Supporting physician assistant training in primary care.
  • Increasing the number of nurse practitioners trained in primary care.
  • Establishing new clinics led by nurse practitioners.
  • Encouraging states to better plan for their health care workforce needs.

This new funding -- part of the Prevention and Public Health Fund -- is only one component of the health reform law's strategy for addressing the primary care shortage. Other provisions will reallocate Medicare funds for primary care residencies as well as increase resources for:

  • Education and worker training (including forgiveness of education loans for doctors who go into primary care).
  • Scholarships.
  • Grants for career training.
  • Tax benefits for health professionals working in underserved areas like primary care.