Suneel Dhand via Kevin.MD / October 17, 2019
Working in both the inpatient and outpatient setting, I have to frequently recommend my patients follow-up as soon as possible with their primary care doctors. I work in a couple of different locations, urban and rural, and I must say I have noticed a rather disturbing trend over the last few years. When I ask my patients who their primary care doctor is, I often get the reply:
“My primary care doctor just left the practice.”
“I keep seeing a different doctor every time I go to the clinic.”
“My doctor has cut back their practice.”
“My doctor is about to retire.”
“I don’t know, I haven’t seen him/her for a while, and always see a different NP/PA.”
I would say the first answer above is the most common, that their doctor has either switched to another job or moved away. Most of the time too, I hear those words leave the mouth of an older medically complex patient who desperately needs good follow-up. I have written previously about how our primary care system is broken. I would like to add another word to that: Primary care is completely broken.
If we’re talking about trying to improve any health care system, it should be common sense that strong primary care is the backbone of great medicine. A focus on continuous relationships, regular follow-up, and preventive medicine—has to be at the core of any future endeavors to build a solid health care system. What the devil is going in America right now? Why is our primary care imploding? I grew up in the United Kingdom, which is generally thought of as having a strong general practitioner system. My parents and extended family are still there, near London. From talking to family and friends, I hear similar stories: “We used to have a family doctor 20 years ago, but now our GP practice is full of locum doctors.”
So the problem is not just unique to the United States. Why have we allowed this to happen? Why have we made being a primary care physician such a difficult job that no talented young medical student wants to go into it? And for those that do, why don’t they stick with it?
In the United States, it’s for a number of reasons including pay being very low compared to other specialists, appointment slots being ridiculously small, and the volume of computer work required on clunky electronic medical records sapping the life out of any physician’s soul. This is a terrific shame. Our collective attitude to primary care makes no sense at all. We spend billions of dollars on questionable technology and billions of dollars on treatments with questionable beneficial outcomes. Layers upon layers of bureaucracy also ensure skyrocketing costs in health care. Imagine we just spent a fraction of that money on training and keeping more primary physicians all across America — it would result in a sea change to the health and wellbeing of Americans.
I hope we find a way to reverse this ship somehow. If it was up to me, I would make primary care one of the highest-paid specialties, and also make the work environment so attractive that only the best graduates would want to do it. Society is yearning for a time to restore good community physicians who stay in their jobs and provide the outpatient care that’s so desperately needed for our patients.