Lucia Agajanian, a 25-year-old freelance film producer in Chicago, doesn’t have a specific primary care doctor, preferring the convenience of visiting a local clinic for flu shots or going online for video visits. “You say what you need, and there’s a 15-minute wait time,” she said, explaining how her appointments usually work. “I really liked that.”
But Olga Lucia Torres, a 52-year-old who teaches narrative medicine classes at Columbia University in New York, misses her longtime primary care doctor, who kept tabs for two decades on her conditions, including lupus and rheumatoid arthritis, and made sure she was up to date on vaccines and screening tests. Two years ago, Torres received a letter informing her that he was changing to a “boutique practice” and would charge a retainer fee of $10,000 for her to stay on as a patient.
“I felt really sad and abandoned,” Torres said. “This was my PCP. I was like, ‘Dude, I thought we were in this together!’”
The two women reflect an ongoing reality: The primary care landscape is changing in ways that could shape patients’ access and quality of care now and for decades to come. A solid and enduring relationship with a primary care doctor — who knows a patient’s history and can monitor new problems — has long been regarded as the bedrock of a quality health care system. But investment in primary care in the U.S.lags behindthat of other high-income countries, and America has a smaller share of primary care physicians than most of its European counterparts.
An estimated one-third of all physicians in the U.S. are primary care doctors — who include family medicine physicians, general internists, and pediatricians — according to the Robert Graham Center, a research and analysis organization that studies primary care. Other researchers say the numbers are lower, with thePeterson-KFF Health System Trackerreporting only 12% of U.S. doctors are generalists, compared with 23% in Germany and as many as 45% in the Netherlands.
That means it’s often hard to find a doctor and make an appointment that’s not weeks or months away.
“This is a problem that has been simmering and now beginning to erupt in some communities at a boil. It’s hard to find that front door of the health system,” said Ann Greiner, president and CEO of thePrimary Care Collaborative, a nonprofit membership organization.
Investment in primary care workforce lags
Though having good access to primary care has traditionally been linked to better health, U.S. investment in that workforce lags behind that of other high-income countries. Today, a smaller percentage of physicians are entering the field than are practicing, suggesting thatshortages will worsen over time.
Interest has waned partly because, in the U.S., primary care yields lower salaries than other medical and surgical specialties.
Some doctors now in practice also say they are burned out, facing cumbersome electronic health record systems and limits on appointment times, making it harder to get to know a patient and establish a relationship.
Others are retiring or selling their practices. Hospitals, insurers like Aetna-CVS Health, and other corporate entities like Amazonare on a buying spree, snapping up primary care practices, furthering a move away from the “Marcus Welby, M.D.”-style neighborhood doctor. About 48% of primary care physicians currently work in practices they do not own. Two-thirds of those doctors don’t work for other physicians but are employed by private equity investors or other corporate entities, according to data in the “Primary Care Chartbook,” which is collected and published by the Graham Center.
Patients who seek care at these offices may not be seen by the same doctor at every visit. Indeed, they may not be seen by a doctor at all but by a paraprofessional — a nurse practitioner or a physician assistant, for instance — who works under the doctor’s license. That trend has been accelerated by new state laws — as well as changes in Medicare policy — that loosen the requirements for physician supervisors and billing. And these jobs are expectedto be among the decade’s fastest-growingin the health sector.
Primary care demand on the rise
Overall, demand for primary care is up, spurred partly by record enrollment in Affordable Care Act plans. All those new patients, combined with the low supply of doctors, are contributing to ayears-long downward trendin the number of people reporting they have a usual source of care, be it an individual doctor or a specific clinic or practice.
Researchers say that raises questions, including whether people can’t find a primary care doctor, can’t afford one, or simply no longer want an established relationship.
“Is it poor access or problems with the supply of providers? Does it reflect a societal disconnection, a go-it-alone phenomenon?” askedChristopher Koller, president of the Milbank Memorial Fund, a foundation whose nonpartisan analyses focus on state health policy.
For patients, frustrating wait times are one result. A recentsurvey by a physician staffing firmfound it now takes an average of 21 days just to get in to see a doctor of family medicine, defined as a subgroup of primary care, which includes general internists and pediatricians. Those physicians are many patients’ first stop for health care. That runs counter to the trend in other countries, where patients complain of months- or years-long waits for elective procedures like hip replacements but generally experience short waits for primary care visits.
Another complication: All these factors are adding urgency to ongoing concerns about attracting new primary care physicians to the specialty.
When she was in medical school, Natalie A. Cameron said, she specifically chose primary care because she enjoyed forming relationships with patients and because “I’m specifically interested in prevention and women’s health, and you do a lot of that in primary care.” The 33-year-old is currently an instructor of medicine at Northwestern University, where she also sees patients at a primary care practice.
Still, she understands why many of her colleagues chose something else. For some, it’s the pay differential. For others, it’s because of primary care’s reputation for involving “a lot of care and paperwork and coordinating a lot of issues that may not just be medical,” Cameron said.
Patients turning to urgent care and retail clinics
The million-dollar question, then, is how much does having a usual source of care influence medical outcomes and cost? And for which kinds of patients is having a close relationship with a doctor important? While studies show that many young people value the convenience of visiting urgent care — especially when it takes so long to see a primary care doctor — will their long-term health suffer because of that strategy?
Many patients — particularly the young and generally healthy ones — shrug at the new normal, embracing alternatives that require less waiting. These options are particularly attractive to millennials,who tell focus groupsthat the convenience of a one-off video call or visit to a big-box store clinic trumps a long-standing relationship with a doctor, especially if they have to wait days, weeks, or longer for a traditional appointment.
“The doctor I have is a family friend, but definitely I would take access and ease over a relationship,” said Matt Degn, 24, who says it can take two to three months to book a routine appointment in Salt Lake City, where he lives.
Patients are increasingly turning to what are dubbed “retail clinics,” such as CVS’ Minute Clinics, which tout “in-person and virtual care 7 days a week.” CVS Health’s more than 1,000 clinics inside stores across the U.S. treated more than 5 million people last year, Creagh Milford, a physician and the company’s senior vice president of retail health, said in a written statement. He cited a recent study by adata products firmshowing the use of retail clinicshas grown 200%over the past five years.
Health policy experts say increased access to alternatives can be good, but forgoing an ongoing relationship to a regular provider is not, especially as people get older and are more likely to develop chronic conditions or other medical problems.
“There’s a lot of data that show communities with a lot of primary care have better health,” said Koller.
How will patient health be impacted?
People with aregular primary caredoctor or practice are more likely to get preventive care, such as cancer screenings or flu shots, studies show, and areless likely to dieif they do suffer a heart attack.
Physicians who see patients regularly are better able to spot patterns of seemingly minor concerns that could add up to a serious health issue.
“What happens when you go to four different providers on four platforms for urinary tract infections because, well, they are just UTIs,” posed Yalda Jabbarpour, a family physician practicing in Washington, D.C., and the director of the Robert Graham Center for Policy Studies. “But actually, you have a large kidney stone that’s causing your UTI or have some sort of immune deficiency like diabetes that’s causing frequent UTIs. But no one tested you.”
Most experts agree that figuring out how to coordinate care amid this changing landscape and make it more accessible without undermining quality — even when different doctors, locations, health systems, and electronic health records are involved — will be as complex as the pressures causing long waits and less interest in today’s primary care market.
And experiences sometimes lead patients to change their minds.
There’s something to be said for establishing a relationship, said Agajanian, in Chicago. She’s rethinking her decision to cobble together care, rather than have a specific primary care doctor or clinic, following an injury at work last year that led to shoulder surgery.
“As I’m getting older, even though I’m still young,” she said, “I have all these problems with my body, and it would be nice to have a consistent person who knows all my problems to talk with.”
KFF Health News’ Colleen DeGuzman contributed to this report.
KFF Health News, formerly known as Kaiser Health News (KHN), is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs atKFF, an independent source for health policy research, polling, and journalism.
FAQs
How do you see healthcare evolving in the next 10 years? ›
Ten trends for the next decade are evident: 1) more patients, 2) more technology, 3) more information, 4) the patient as the ultimate consumer, 5) development of a different delivery model, 6) innovation driven by competition, 7) increasing costs, 8) increasing numbers of uninsured, 9) less pay for providers, and 10) ...
Can you be refused medical treatment in the US? ›Yes, a doctor can deny you medical treatment. Private doctors have some more leeway to deny treatment to patients than those in Medicare-compliant hospitals, but there are circumstances under which even doctors serving Medicare patients may choose not to serve a patient.
Why is medicine constantly changing? ›Advances in Technology
Undoubtedly the biggest factor in healthcare's rapid change is constantly advancing technology. Professional researchers and scientists are forever searching for better ways to heal and help people: better machines, better techniques, better medicine.
The country faces a shortage of up to 124,000 physicians by 2034, including 48,000 primary care physicians, according to the Association of American Medical Colleges. Hospitals are currently facing shortages of registered nurses as burnout and other factors drive them to other roles.
What to expect in 2023 in healthcare? ›The US healthcare industry faces demanding conditions in 2023, including recessionary pressure, continuing high inflation rates, labor shortages, and endemic COVID-19. But players are not standing still.
What does the future of healthcare look like in the US? ›Our analysis finds that national health expenditure could grow at a rate of 7.1 percent over the next five years from 2022 to 2027, compared with an expected economic growth rate of 4.7 percent. In aggregate, this would equate to healthcare expenditure growth in excess of economic growth of 2.4 percentage points.
What does the Bible say about refusing medical treatment? ›Jesus said: “It is not the healthy who need a doctor, but the sick”—Matthew 9:12. For any one who is sick or a pregnant woman who needs medical attention but refuses a medical treatment is acting in ignorance of the Divine Providence.
What happens if you can t afford medical treatment in america? ›By federal law, nonprofit hospitals must offer financial assistance to those who cannot pay their bills. Some states also have other laws about uncompensated care, such as Washington, where all hospitals must tell patients about financial assistance programs when they receive care.
What does the Constitution say about medical freedom? ›at 331 (Stevens, J., dissenting) ( [A] competent individual's decision to refuse life-sustaining medical procedures is an aspect of liberty protected by the Due Process Clause of the Fourteenth Amendment. ).
Would doctors choose medicine again? ›In pandemic's wake, only 57% of doctors would choose medicine again | American Medical Association.
Why do doctors prescribe unnecessary medication? ›
Doctors also may be over-prescribing because they fear a lawsuit, are trying to be proactive by practicing defensive medical decision making or because they are trying to adhere to clinical performance measures that require a one-size-fits-all treatment approach for patients.
Why is the healthcare industry so complex today? ›There are many different types of caregivers who work in labs, pharmacies, therapies, bed management and so on. All those teams have to work together to coordinate care for every patient. The industry is intense as well as complex because it deals with people's health, and some situations are urgent.
What state needs doctors the most? ›- Pennsylvania.
- Illinois. ...
- Wisconsin. ...
- Florida. ...
- Indiana. ...
- North Carolina. ...
- Texas. ...
- Arizona. Nearly three million of Arizona's seven million residents have limited access to primary care doctors, with the biggest shortage in rural areas. ...
California, Florida and Texas are the three states expected to have the greatest estimated physician shortage by 2030, according to the U.S. National Institutes of Health's Library of Medicine.
What is the biggest healthcare issue in America? ›The High Cost of Health Care
The problem: Perhaps the most pressing issue in health care currently is the high cost of care. More than 45% of American adults say it's difficult to afford health care, according to a survey by the Kaiser Family Foundation, and more than 40% have medical debt.
Starting January 2023, Medi-Cal health coverage for most remaining dually eligible beneficiaries changed from Fee-For-Service (FFS) Medi-Cal to Medi-Cal Managed Care. Medi-Cal managed care enrollment does NOT affect a beneficiary's Medicare providers or Medicare Advantage plan.
How much will medical cost increase for 2023? ›For individuals, average cost is projected to be $7,221 in 2023, increasing from $6,813 last year. About half of the average person's healthcare expenses are for inpatient and outpatient hospital services, which the index projects will increase 4.2% this year due to more utilization and inflationary pressures.
What will federal health rates be in 2023? ›For 2023, the biweekly program-wide weighted average premiums for Self Only, Self Plus One, and Self and Family enrollments with a government contribution are $360.72, $778.50, and $849.19, respectively.
Why is healthcare so difficult in the US? ›After years of poor funding and a deluge of demand since the pandemic began, providers are in short supply. Scarcity is coupled with barriers imposed by insurance networks.
Why does the US rank last in healthcare? ›The U.S. ranks last. U.S. doctors are the most likely to have trouble getting their patients medication or treatment because of restrictions on insurance coverage. Compared to most of the other countries, larger percentages of adults in the U.S. say they spend a lot of time on paperwork related to medical bills.
Is health declining in the US? ›
The decline in America's health has been described in the public health literature for decades and has long been hypothesized to be attributable to an array of worsening psychosocial problems that are not specific to Whites.
What does God say about medical treatment? ›We should always seek help from God as well as going for appropriate medical treatment - not instead of doing so. In Matthew 9, the Pharisees asked Jesus why he spent time with sinners. He replied, 'It is not the healthy who need a doctor, but the sick' (Matthew 9:12). Jesus recognised that sick people need doctors.
Can Christians refuse medical treatment? ›Members of the Followers of Christ religious group, for example, refuse all medical care in favor of “faith-healing” rituals. They prefer scented oils and prayer over medical treatment. Members of the group say they will not go to a hospital in any event, even if it is a life-or-death situation.
What does the Bible say about medical surgeries? ›The only surgical operations mentioned in the Bible are circumcision and castration, the former being mandatory – a covenant made with Abraham (Genesis 17:10-11), and the latter being forbidden (Deuteronomy 23:2).
Will medical debt be forgiven? ›It's unlikely you'll get your medical debt forgiven, but there are ways to get some financial relief for those who qualify. Consider hospital forgiveness programs, assistance from specialized organizations and government assistance programs.
How much of the US population Cannot afford healthcare? ›The proportion of Americans with difficulty affording health care varies by income and health insurance coverage. Overall, 16.9% of Americans report at least 1 financial barrier.
What percent of the US can't afford healthcare? ›Coverage gains were greater for nonelderly adults compared to children. The uninsured rate for nonelderly adults fell nearly 0.8 percentage points from 12.9% in 2019 to 12.2% in 2021 while the uninsured rate for children dropped a more modest 0.3 percentage points from 5.6% to 5.3% (Figure 3).
Is healthcare a human right or a privilege in the US? ›Health care is a right not a privilege. When you or a loved one is ill or injured you should have access to a doctor, medication and treatment.
Do US citizens have a constitutional right to health care? ›With respect to human rights, the United States has no formally codified right to health, nor does it participate in a human rights treaty that specifies a right to health.
Do all Americans have a constitutional right to health care? ›The full text of the America's Right to Health Care Amendment is below: Section 1. Health care, including care to prevent and treat illness, is the right of all citizens of the United States and necessary to ensure the strength of the Nation.
Will doctors be replaced by technology? ›
“Doctors will not be replaced by AI, but they may not directly profit from it either,” Dranove says. And it's not clear if even the healthcare organization will get monetary rewards. Medical care in the United States is often based on a fee-for-service model.
Are more doctors quitting? ›In 2021 alone, around 117,000 left the workforce. And one in five doctors say that they plan to leave in the coming years.
Has there been a decline in doctors? ›Healthcare in America itself may deteriorate for certain communities due to the shortage of medical professionals; the potential harm caused by the lack of access to specialty services in rural locations has garnered specific attention. The AMA has reported shortages already causing stress among U.S. patients.
What are the most over prescribed drugs? ›Common Overprescriptions. Although the overprescription of any drug is potentially dangerous, the most commonly abused are opioids, benzodiazepines, and stimulant drugs used to treat Attention Deficit Disorder. Opioids are usually used as a short-term measure post-surgery or for acute pain[4].
Which country takes the most prescription drugs? ›- Data suggests that among those who take prescription medications, the average number of medications taken is four. ...
- Research on prescription drug spending suggests that the United States consumes the most prescription drugs.
Under this statute, it is illegal for a physician to receive remuneration for referring a patient for a service that will be paid in whole or in part by a federal health care program or for prescribing or recommending the purchase of a drug that will be paid in whole or in part by a federal health care program.
What country has the best healthcare system? ›Healthcare System Performance Ranking
Key findings: “The top-performing countries overall are Norway, the Netherlands, and Australia. The United States ranks last overall, despite spending far more of its gross domestic product on health care.
The United States is the biggest economy, as well as the most technologically advanced country in the world. When it comes to the academic field of clinical medicine, it is the number one country in terms of average number of citations per paper.
Who has free healthcare in the world? ›However, Brazil is the only country in the world that offers free healthcare for all its citizens. Also, Norway is the first country in the world to implement a free healthcare policy as far back as 1912.
Which state has the best healthcare? ›Hawaii is the top state for healthcare, according to U.S. News & World Report's annual best states rankings published May 2. The overall state ranking is based on 71 metrics across eight categories, including healthcare, education and economy.
What is the lowest paying state for doctors? ›
Maryland physicians earned the lowest salary on average in 2022, according to Medscape's 2023 "Physician Compensation Report." The study surveyed more than 10,000 physicians across 29 specialties. California, Florida, Texas, Arizona and Georgia are expected to have the largest physician shortages by 2030.
What city in the US has the best doctors? ›- Atlanta, Georgia. According to one expert, “Doctors like Atlanta because of its booming economy and high quality of education and hospitals . . .
- Jacksonville, Florida. ...
- Salt Lake City, Utah. ...
- Charlotte, North Carolina. ...
- Boise, Idaho. ...
- Austin, Texas. ...
- Boulder, Colorado. ...
- Orlando, Florida. ...
- Primary care physicians: Primary care physicians specialize in family medicine, internal medicine, geriatrics and pediatrics and are often the first point of contact for patients. ...
- Internal medicine. ...
- Emergency medicine. ...
- Psychiatry. ...
- Gynecology. ...
- Neurology. ...
- Radiology.
The latest Doximity poll, conducted between October 2022 and January 2023, includes the responses of 2,851 physicians, pharmacists, and APPs. The vast majority of clinicians in each profession agree they are overworked: 86% of physicians, 87% of NPs and CRNAs, 88% of PAs, and 88% of pharmacists.
Which doctors are most in demand in US? ›- Family physicians. ...
- Internists. ...
- Emergency physicians. ...
- Psychiatrists. ...
- Obstetricians and gynecologists. ...
- Neurologists. ...
- Radiologists. ...
- Anesthesiologists.
The No. 1 health condition in the U.S. is heart disease. It is one of the leading causes of death, comprising more than a quarter of all deaths annually.
What are the top 3 leading health problems in America? ›- Physical Activity and Nutrition. ...
- Overweight and Obesity. ...
- Tobacco. ...
- Substance Abuse. ...
- HIV/AIDS. ...
- Mental Health. ...
- Injury and Violence. ...
- Environmental Quality.
By federal law, nonprofit hospitals must offer financial assistance to those who cannot pay their bills. Some states also have other laws about uncompensated care, such as Washington, where all hospitals must tell patients about financial assistance programs when they receive care.
How is health care evolving? ›Technological advancements contribute to a shift in our patient-centered healthcare system. This trend is expected to continue as new healthcare electronic technologies, such as 3D printing, wearable biometric devices, and GPS tracking, are tested and introduced for clinical use.
How is the healthcare industry evolving? ›Healthcare industry EBITDA grew 5 percent pre-COVID-19 (between 2017 and 2019) and remained flat over 2020 and 2021. We estimate post-COVID-19 (between 2021 and 2025) growth at 6 percent (Exhibit 1). If the industry achieves this rate of growth, it could add about $31 billion in profits 2.
What are the future changes in healthcare? ›
In the future of health, we expect six key areas—data sharing, interoperability, equitable access, empowered consumers, behavior change, and scientific breakthrough—to collectively transform the existing health system from treatment-based reactionary care to prevention and well-being.
What technology will have the biggest impact on healthcare in the next 10 years? ›In the next decade, clinicians will have the ability to use blockchain, machine learning, and artificial intelligence seamlessly to provide specialized care to patients, says Jain.
What will medicine be like in 2030? ›- Wearable technology monitors patient health. ...
- Genetic testing and genomic profiling are widely used. ...
- Telehealth is used for initial primary care appointments. ...
- Increased access to health analytics. ...
- Improved health outcomes.
The evolution of this complex includes the acceptance of the "germ theory" as the cause of disease, professionalization of doctors, technological advancements in treating disease, the rise of great institutions of medical training and healing, and the advent of medical insurance.
Why is healthcare so hard to change? ›“The prospect of changing the health care system generates resistance because there are huge economic interests vested in the current structure: pharmaceutical, construction, equipment, information technology. It is the largest sector of the U.S. economy and 10 percent of the global economy.
How can healthcare be improved in the United States? ›- Focus on Improving Health. ...
- Tackle Racial Disparities. ...
- Expand Telehealth and In-Home Hospital Services. ...
- Build Integrated Systems. ...
- Adopt Value-Based Care.
The U.S. has improved in use of technology in healthcare. In 2008, only 9% of hospitals had electronic medical records. By 2015, 84% of hospitals had EMRs, which is similar to other countries on average. Quality in the U.S. has improved but it continues to lag behind other OECD countries.
How can healthcare be improved in the future? ›- Surprise Medical Billing. ...
- Increasing Competition to Reduce Drug Prices. ...
- Expanding Adoption of Health Care Innovations. ...
- Transparency for Patients Without the Risk. ...
- Protecting Medicare Advantage and Medicaid.
- Wearable Technology. Recently, wearable technology has gained immense popularity, and this trend appears to continue to rise. ...
- Artificial Intelligence In Healthcare. ...
- Augmented Reality. ...
- 3D Printing. ...
- Telehealth. ...
- Precision Medicine. ...
- Genomics.
1. The High Cost of Health Care. The problem: Perhaps the most pressing issue in health care currently is the high cost of care. More than 45% of American adults say it's difficult to afford health care, according to a survey by the Kaiser Family Foundation, and more than 40% have medical debt.
What is a major trend in healthcare now? ›
1. Rise of Telemedicine and Virtual Healthcare Services. According to the recently published report Telemedicine Market – Growth, Trends, COVID-19 Impact, and Forecasts (2023-2028) by Mordor Intelligence, the increasing use of telemedicine and virtual healthcare services is considered a major trend to watch.
Who has the most advanced medical technology? ›The United States is the biggest economy, as well as the most technologically advanced country in the world. When it comes to the academic field of clinical medicine, it is the number one country in terms of average number of citations per paper.
How will technology change for doctors in the future? ›We will continue to see more advanced technology such as artificial intelligence (AI) and machine learning (ML) leveraged for predictive analytics in healthcare. Valuable tools that are constantly undergoing innovation, AI and ML can help enable potentially life-saving predictions for patients.
What are the 5 trends in health care? ›- Rise of Telemedicine and Virtual Healthcare Services. ...
- Growth of AI and Machine Learning in Healthcare. ...
- Value-Based Care Gains Momentum. ...
- New Wearables and Remote Monitoring Devices. ...
- Importance of Healthcare Cybersecurity.