The dwindling availability of primary care doctors
September 11, 2023
The shortage of primary care doctors has been years -- if not decades -- in the making. KFF Health News reported on the percentage of doctor visits that are for primary care declining from 62% in 1980 to 38% in 2013. Many people blame the reimbursement system for valuing specialty care over primary care, and therefore attracting more medical school graduates into specialty fields. At the same time, many feel that primary care is valuable because it can identify and address issues before they become severe enough to warrant the more expensive specialty care. The article also pointed out how current payment structures essentially force primary care providers to squeeze patients into a much tighter schedule, leading to less satisfied patients and likely worse quality of care.
Theoretically, prices paid for doctors' services would fluctuate in a free market and self-correct such that scarcity of primary care would drive prices up, attracting more doctors to the field. However, health care is not a free market. Relative values of one procedure compared to another procedure are determined by a committee, and the payers (health insurance companies) are dominated by large players, making it difficult for small provider offices to negotiate and switch. Even still, if it is indeed true that primary care can save the overall system money, it seems that some payers would figure out how to capitalize on the current trends and perform better than some other competitors. For now, the industry is watching Medicare try out value-based care, which probably better recognizes the value of primary care compared to the older fee-for-service model.