In the past five years I have had four primary care physicians. No, I am not a difficult patient, I am the product of changing dynamics in the practice of primary care.

Five years ago, I had a primary care physician I really liked. She listened to me and provided good quality care.

However, she was struggling. As the healthcare industry shifted to volume-based care, it limited her ability to offer a quality experience for her patients. She was challenged with rising operating costs, a larger administrative burden, and cuts in insurance reimbursement. 

So, she decided to “go concierge.”

She transitioned her practice to one that charges a membership fee of $2,000 per year. These membership or concierge fees are not covered by insurance. This out-of-pocket cost for the patient covers an in-depth physical exam and screenings.  

One of the benefits to her of this arrangement was that she could reduce her patient load to only 300 patients - from over 2,500 - and provide more personalized comprehensive care. Her patients would have access to conversations with her via email or phone regarding their health and treatment and receive same day or next day appointments for sick care.

After careful consideration and given the fact that I do not have any significant health conditions to contend with, I decided to look for another primary care doctor.

I spoke with friends and my hospital contacts and found a new physician that was highly rated, well respected and worked within the traditional system of primary care. She was my doctor for about a year until she too decided to transition to a concierge practice.

She referred me to another physician she had partnered who was staying with the traditional system, but after a few months, that physician also transitioned to concierge care.

Back on the market again, I resumed my search.

This time I found a doctor that for the moment, has no intention to transition to a concierge practice. She has experience within a hospital system, has outstanding patient care scores and was recommended to me by people I trust.

It did take me quite a few months to get that first appointment, but I was OK with that. After my first few interactions with her, when friends asked me for a primary care recommendation, I suggested her.

I recently found out she has closed her practice to new patients.

This entire process has educated me about the country’s significant shortage of primary care physicians.  Several factors are to blame, one of them being the allure of going concierge.

Second, more and more doctors who might have practiced primary care have opted to become hospitalists. A hospitalist is a physician who cares for inpatients, meaning they only work inside a hospital.   

Hospitalists came about in response to the increasingly difficulty for office-based physicians to check on their hospitalized patients before or after a long day of seeing people in their offices. Because hospitalists only work in the hospital setting, they know how to navigate the hospital staff and protocols.

Another reason we are seeing a shortage of primary care doctors is that more physicians are reaching retirement age. 

According to a recent study more than two of five active physicians will be 65 or older in the next decade, and with the burden of the healthcare shift to volume-based care, many are retiring.

Lastly, there is a greater need for more primary care doctors as we see significant growth in the over 65 population who require more medical care. Between 2020 and 2035 that population is expected to grow over 45%.

My experience is unfortunately not unique. 

A 2019 poll conducted on behalf of the Association of American Medical Colleges showed that 35% of those polled had trouble finding a doctor in the past two to three years, and that was 10 points higher than when the question was asked in 2015. 

The next time you have an appointment with your primary care physician, give them a kind word. They are the guide to your health and wellbeing and the front line in our healthcare system.