Where have all the primary-care doctors gone? | Expert Opinion

If you’ve found yourself struggling to find a primary care doctor, you’re not alone. While the U.S. has plenty of specialists and subspecialists, physicians who provide primary care (family medicine, internal medicine, pediatrics, and some OB/GYN) are in short supply. The reasons for this are complex but many of them boil down to simple economics.

Primary care physicians (PCPs) are on the front line of preventing disease; a big part of their job is educating patients on health and wellness and ordering testing to evaluate for potential problems (pap smears for cervical cancer screening, mammograms, blood tests for cholesterol and kidney function, etc.). The annual wellness visit often includes discussion of diet and exercise, vaccine counseling, reviewing substance use, teaching safe sex practices, and so on.

No one doubts the importance of this work, but unfortunately health insurers don’t pay for all of it. Insurance coverage (private and government-funded) pays far more for procedures (colonoscopies, surgery, etc.) and specialized care than it does for preventive care done by PCPs. So physicians generally earn far more in specialties than working in primary care.

In addition, the cost of medical school has steadily risen and many doctors graduate with staggering amounts of student loan debt. Even those who love primary care may decide to pursue a more lucrative specialty, further decreasing the number of PCPs.

Over the past few decades, the number of smaller, physician-owned primary care practices has declined as regional health systems have grown. Many PCPs who had their own practices closed due to shifting populations (from rural to suburban or urban), insurance hurdles, and the competition from larger health systems.

Then there is the rapidly growing population of older adults; the baby boom generation has hit retirement age. We have nowhere near enough primary care doctors who specialize in care of the elderly, called geriatricians. This was compounded by many PCPs who retired during or immediately after the COVID pandemic. This has resulted in far fewer PCPs than even a decade ago. In an attempt to remedy this, many health systems employ advanced practice providers (APPs) like nurse practitioners and physician’s assistants. This doesn’t solve the issue if you are looking for a board-certified primary care physician. In fact in some cases it has made it harder for PCPs to find employment as they demand higher salaries given their additional training and expertise.

Unfortunately, there are no easy solutions to these issues. If you’re in the market for a new PCP you may have to do some work to find one. Here are some tips for your search.

Word of mouth. Ask your friends and family if they have a PCP they like. A personal recommendation can go a long way in motivating you to call and set up a visit.

Check your insurance website. While not always up to date, the site lists PCPs who accept your insurance. You can then filter by zip code and radius in which you want to travel to find your best options. The website should also tell you which offices are accepting new patients, but you will have to call the office to be sure the information is current.

Consider a regional health system like Jefferson or Penn. Many PCPs now work under the umbrella of a larger health system, which may own dozens of offices. If you live in a place where one (or more) health systems exist, you’ll likely be able to find an affiliated practice accepting new patients.

Pay more out-of-pocket. Many PCPs are now offering new models of care called Direct Primary Care (DPC) and Concierge Medicine. These practices require patients to pay a monthly or yearly fee in exchange for increased access to the PCP. Not only does this include unlimited office visits, there may also be perks like guaranteed same-day visits, an option to call the PCP for after-hours advice, house calls, and more. The additional fees help the PCPs keep their practices relatively small, allowing them more time and attention for their patients. The fees also cover much of the time PCPs spend doing work that insurance companies don’t pay for, like answering questions by email or phone call, reviewing lab results, completing forms. The drawback: fees that patients pay to join this kind of practice are not covered by insurance, though labs, radiology, and visits to other specialists still are.

Amanda Finegold Swain is a family medicine physician in the University of Pennsylvania Health System.