If you’ve been hearing a lot about the lack of primary care or family physicians in the United States lately, you haven’t imagined it: The problem appears to be getting worse. According to research released by the Association of American Medical Colleges in March 2017, “the estimated shortage [of primary care physicians] will be between 8,700 and 43,100 physicians by 2030.”
This is alarming because we know that primary care is important to maintaining health. The primary care physician or family doctor is the doctor you’ll see for routine health care, chronic conditions and a range of other illnesses and diseases you may encounter over the course of your lifetime. The American Academy of Family Physicians says studies have suggested that “as many as 127,617 deaths per year in the United states could be averted through an increase in the number of primary care physicians available.”
[See: 10 Lessons From Empowered Patients.]
So having someone who can manage your care is important, but what should you do if you live somewhere where that looming PCP shortage is already a problem? In some rural and underserved parts of the country, finding a primary care physician who’s taking new patients can be frustratingly difficult.
“In the short term, there’s no easy way to answer this,” says Dr. Warren Newton, incoming president and CEO of the American Board of Family Medicine and executive director of the North Carolina Area Health Education Center. “This is a real issue, so the first thing is to acknowledge that. The second is to say, ‘what are the other sources of care?'”
Other sources of care could mean visiting an urgent care clinic, but Newton says it’s important to “keep in mind what most patients want. You want a place of care that can do almost everything you need done and can coordinate the care you need. You also want somebody you’ll have an interaction with over time. Particularly the sicker you are, and if you have a chronic disease, the dilemma with some purely urgent care settings is they’ll take care of only this one problem, and it can dis-coordinate care for people with more than one medical problem.”
Dr. Jay Ladde, associate program director and professor of emergency medicine at Orlando Health, says if the medical issue you’re having is significant or needs more attention than the urgent care center can provide, you should go to the emergency department. But for ongoing care, he suggests checking online for local options through county or municipal health centers. He also suggests calling your local hospital for help. “If you called our hospital case managers, they can often redirect you and get you plugged in with various clinics.” He says there’s often more options open to people than they realize and it’s worth asking for help. “Sometimes it’s not perfect and sometimes there isn’t anything in place — that’s the worst-case scenario. But there are a lot of things out there that exist that people don’t realize are available to them.”
Dr. Michael Munger, president of the American Academy of Family Physicians, also recommends reaching out to a local medical society. “Many local medical societies will have a directory of physicians, and many times, that’s your best source to help get directed to who’s accepting new patients.” Your insurance company may also be able to help you connect with a doctor locally.
If you are able to find a doctor who will see you but is perhaps based too far away to make regular visits feasible, telemedicine might be an option for getting care when you need it. In a telemedicine setting, the doctor assesses the patient either over the phone or through a video chat. “It works best when you know the person,” and have an established relationship with the doctor, Warren notes. But it can save a trip to the doctor’s office in some cases.
Warren also cautions against getting hung up on the term “primary care physician.” “It’s not just the label. It’s those things that I’m looking for. It’s taking care of almost all the [health] problems [a patient might have]. It’s somebody you can talk to about whether or not you need this procedure.” He says you can sometimes find this sort of health ally in several places, not just a PCP or family doctor.
[See: 14 Things You Didn’t Know About Nurses.]
Munger also recommends expanding your definition of the primary care physician to include other clinicians in the office. These are caregivers who may be able to help you in “primary care practices that are using a team approach, ones that recognize primary care is a team sport.” He says in these settings there’s one or more primary care doctors in the practice, but they may be assisted by nurse practitioners or physician assistants who are well equipped to deal with most situations and can coordinate with other members of the care team as needed. “Nurse practitioners and physician assistants are very valuable as part of the overall team that takes care of patients,” Munger says.
He also recommends finding a primary care physician before you need one. “I think it’s always important to establish a rapport with your family physician before you need them. You might say, ‘I’m in my 30s or early 40s, and I’m invincible. I don’t need to see a doctor.’ But if and when you find yourself in a crisis situation, that’s when you need the physician. That’s when you need that relationship and that rapport. I think being proactive in getting established early is a good strategy for patients.”
Munger says the current physician shortage results from several factors, not least of which is the staggering cost of medical education in America today. “If you look at compensation, the lowest paying specialties are pediatrics, family medicine, and general internal medicine. These are extremely bright students that are coming out of medical school with debt sometimes cresting $400,000.” For some of these young doctors, getting into a more lucrative branch of medicine is appealing.
“So that’s part of it, but that’s not all of it,” Munger says, citing administrative burdens that primary care doctors often feel “quite heavily,” which can limit the amount of time the doctor has for direct patient care.
A third factor is training. “Right now, in most academic medical centers there’s not as much primary care presence or family medicine presence. It’s all subspecialty driven. As your training occurs, you look to your mentors as role models and if they’re all subspecialty care and there’s no community family physician you’re being exposed to,” that can make imagining your life after residency as a family physician challenging.
The AAFP is trying to address this third factor driving the shortfall in primary care physicians through its Teaching Health Center Graduate Medical Education Program. This program funds community-based primary care residency programs. “These primary care and family residency training programs are embedded in community health centers and federally qualified health centers in rural and underserved communities,” Munger says. “As a student going into primary care training, you’re actually training where you’re going to practice, not in a hospital setting.”
[See: 10 Questions Doctors Wish Their Patients Would Ask.]
Munger says hospital training is part of the program, but the emphasis is on learning “in the community, in the ambulatory center and really getting that longitudinal experience like what you’re going to have when you’re in practice,” in a family medicine situation. The program has been in place for nearly six years and Munger says it appears to be working. “The early results have shown that 75 percent of graduates will go into practice within 50 miles of where they’ve trained in rural and underserved areas.”
The hope is that in time, these and other efforts will lead more doctors to select primary care so that the rest of us won’t have to worry about who to call when we get sick.
More from U.S. News
10 Lessons From Empowered Patients
10 Questions Doctors Wish Their Patients Would Ask
14 Things You Didn’t Know About Nurses
What to Do When There Are No Primary Care Physicians Accepting Patients Near You originally appeared on usnews.com
