INNOVATION AND CHANGE
Where Have All the Primary Care Doctors Gone ?
by TOM JAMES , MD
In the mid-1950s , Norman Rockwell painted his famous painting , Before the Shot . Around the same time , Pete Seeger wrote Where Have All the Flowers Gone , a song that became an anthem for the Vietnam era protest songs . But now nearly 70 years later , the Rockwell painting is becoming as anachronistic as the solo practice family doctor . And we find that the Seeger song is being rewritten to become “ Where have all the primary care doctors gone ?”
Is There a PCP Shortage ?
Two years ago , the Association of American Medical Colleges ( AAMC ) estimated that by 2034 there would be a physician deficit in all specialties but would be especially acute in the primary care fields of family physicians , geriatricians , general practitioners , general internists and general pediatricians . The expected shortage of Primary Care Physicians ( PCPs ) is expected to be between 17,800 and 48,000 . 1 Currently , PCPs represent 31.4 % of the total physician population in the U . S . Europe is also seeing a greater decline in PCPs , while still struggling to keep up rates of physicians as a whole for the population .
On the other hand , there are those who argue that there is not a physician shortage , but that primary care doctors are not able to provide adequate access and are too busy with non-medical care activity . Dr . Zeke Emanuel from the University of Pennsylvania states that it is simple arithmetic . He argues that if each primary care physician had a panel of 2,000 patients , there would be no shortage . Alternatively if every patient were to have a 30-minute primary care physician appointment with the estimated 246,000 PCPs in the U . S ., then in a “ standard 2,080 work hour ” calendar , there would be over 100 million appointments for primary care .
Dr . Emanuel goes on to explain his view that there is not a PCP shortage . He indicates that physician time is not spent working at the top of the license . Our electronic medical records are very time-consuming . A number of specialists have a “ scribe ” who does the electronic charting , but very few primary care doctors feel that they can afford that extra expense . Dr . Emanuel also feels that we do too many follow-up visits . He uses simple infections as an example of conditions . He cites the concerns raised by expansion of
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