In this country there is already a significant shortage of primary care physicians ((PCPs), and it is slowly getting worse.
From the Washington Post:
“The percentage of U.S. doctors in adult primary care has been declining for years and is now about 25% — a tipping point beyond which many Americans won’t be able to find a family doctor at all.
Already, more than 100 million Americans don’t have usual access to primary care, a number that has nearly doubled since 2014.”
There are multiple reasons for this. The Covid pandemic obviously prompted a number of older primary care physicians to head for the exits. However, the main reasons for the worsening dearth of primary care physicians go much deeper than Covid. As an example, someone I know opted to leave Southern California, because “if I ever wanted to own a house, it was clear to my wife and I that we had to move. I owed $200,000 in loans, and there was no way that I could pay-off my loans and buy a house in SoCal at the same time.” While this economic dilemma is worse in California, it is a practical and realistic issue just about everywhere in the US, because med school is so expensive. Furthermore, it is worse for primary care physicians because they are at the bottom of the salary remuneration totem-pole.
Again from the Washington Post:
“One explanation for the disappearing primary care doctor is financial. The payment structure in the U.S. health system has long rewarded surgeries and procedures while shortchanging the diagnostic, prescriptive, and preventive work that is the province of primary care. Furthermore, the traditionally independent doctors in this field have little power to negotiate sustainable payments with the mammoth insurers in the U.S. market.”
In general, if you want to attract someone to something, you have to somehow make that something more attractive. As far as convincing med students to become primary care physicians, one would have to guarantee that their future lives would be better … such that they could afford to buy a house, go out to dinner occasionally, and even send their kids to private schools if they wished. To start this could be a simple economic proposal. For example a state could say, “if you become a primary care physician in our state, we (the state) will pay off your school loans over X years.”
For each state the choreography of the guaranteed loan pay-off would be different as the cost of buying a house and the amount owed on the individual loans is much different from state to state, and from individual to individual.
Granted this solution would not address the total deficit of primary care physicians in the US, but would shift this deficit among the different states.
In part 2 I will address the more pressing day-to-day frustrations of PCPs.
6/13/24