Saving Primary Care
In the twenty years I’ve been a primary care physician at the University of Chicago I’ve had the opportunity to do many challenging and interesting things. I ran primary care for seven years, led the implementation of an enterprise-wide electronic medical record system for six years, and served as the assistant vice president for Student Health and Counseling Services for four years. Nowhere else but in academic medicine could a primary care doctor find the opportunity to reinvent himself so often and so dramatically without having to change employers. But since the beginning of 2015 I’ve felt a strong desire to return to my roots—to become a full-time clinician again—so in July I announced that I’d be leaving the university to take care of patients full-time. Almost immediately I found myself filled with a renewed vigor, a remembered sense of purpose–but also with a feeling of dread, because practicing full-time primary care even in the protected environment of academic medicine has, in my view, become untenable.
A Broken Healthcare System
The healthcare landscape in the U.S. seems to have changed more rapidly in the last two years than it has in the last two decades. The Affordable Care Act (ACA) has mandated health insurance for all Americans and made it possible for approximately 30 million more of them to obtain it (link is external). While this is a welcome development, it poses a significant problem: not only is there already a shortage of primary care physicians to care for those currently insured (link is external), but also according to a survey conducted by the Urban Institute in 2012 (link is external), 30% of primary care physicians between the ages of 35-49 and 53% of primary care physicians over the age of 50 want to quit medicine altogether. When we also consider that the rate at which medical students are choosing to enter primary care has plummeted to a mere 2% (link is external), we’re forced to conclude that the shortage of primary care physicians isn’t a looming crisis–it’s a crisis that’s already here.
Indeed, estimates show that the U.S. is 29,800 primary care physicians short of what it needs right now (link is external). What’s more, after taking into consideration the insurance expansion expected from the passage of the ACA, this deficit is expected to grow to 45,400 (link is external) by 2020, and by 2025 it’s estimated that the U.S. will require nearly 52,000 additional primary care physicians (link is external) to absorb an expected increase in the number of office visits, which are predicted to rise (link is external) from the 462 million in 2008 to 565 million in 2025.
This is a problem not just because restricted access to primary care is associated with patient dissatisfaction (link is external), but also because it’s associated with a decrease in the quality of care (link is external) and an increase in the cost of care (link is external). Inadequate primary care, in other words, lies at the heart of the three most pressing problems facing medicine today.