Primary Care Shortage in the Concrete

It is one thing to consider something in the abstract; it is quite another to experience it in the concrete. I’m reminded of the story of the couple watching their children playing in the newly laid concrete in front of their home. The father was furious, and his wife remarked “But, Dear, I thought you loved children.” “I do,” he said, “in the abstract, but not in the concrete.”

It is one thing to read the news in the abstract about the primary care shortage as seen through the eyes of the Council on Physician and Nurse Supply. This national organization was created in response to the emerging shortage of doctors and nurses, estimated to reach 200,000 doctors and 800,000 nurses by 2020. Based in the University of Pennsylvania's Consortium for Health Workforce Research and Policy, CPNS is supported by San Diego-based AMN Healthcare, the nation's largest healthcare staffing organization.

These shortages, the Council warns, may result in

• Inadequate access to care, particularly in rural and inner-city locations.
• Lack of emergency preparedness.
• Decreased ability to expand health care services, with negative effects on local and national economies.

But it is even more telling to look at the shortage through the eyes of a primary care physician. Charles Meyer, MD, editor of Minnesota Medicine and an internist in a four person group, puts the matter in concrete terms in the May issue of Minnesota Medicine, in an issue with the general them of “Doctors Wanted.”

“The forces threatening primary care are economic and practical – with astronomical medical school debt confronting disparate earning potential in medical specialties and 25-patient-50-phone-call days losing out to procedure –based practice. The evidence for primary care’s disappearance is mounting: stagnant or declining applications in primary care residencies, primary care groups searching for years to find a new partner, and individuals making call after call to find a primary care physician taking new patients. Our group of four internists has found the search for a partner to be like hollering into an empty tunnel. My son, healthy, insured, and 26 tried four family practitioners in San Francisco before he found one accept new patients. Staring my 60th birthday in the face, I wonder who will take of me as head into the age of pills and patient-hood.”