The current state of primary care in America is . . . frustration. For numerous reasons, the delivery of primary care services and access to primary care physicians have become increasingly difficult and frustrating. Who hasn’t asked themselves all of these questions?
• Why can’t I just get my doctor on the phone for two minutes?
• Wouldn’t it be so much easier if I could simply text my doctor a question?
• Why can’t I schedule an appointment to see my doctor today?
• What am I supposed to do at night or on the weekend when my doctor’s office is closed and I have a medical issue?
• Why do I have to schedule a different appointment for every problem I need to address?
• Why can’t I see the same doctor every time I come in?
• Why do I have to see a nurse practitioner or physician assistant instead of my doctor?
• Why is the doctor so rushed?
• Why doesn’t the doctor listen?
• Why is my doctor always running way behind schedule?
• Why do I have to fill out all this paperwork every time I go to the doctor’s office?
The fact is, the delivery system for primary care in America is overly taxed to the point that access to primary care physicians and the quality of care are suffering. There are several reasons for this current state and more than a few measurable negative consequences of it. Too many people are not connected with a personal physician over time and are not receiving many of the benefits of primary care.
It is clear that better delivery of primary care would improve population health and decrease costs. Unfortunately, the exact opposite is occurring and seems likely to worsen. Currently, 82 million people in the US (a full 25% of the population) do not have anyone that they recognize as their primary care physician. Sadly, 20% of adults have not seen any doctor within the past year, and only 8% have received all recommended high-priority preventive services.
More recently, nearly 40% of Americans have avoided doctor visits for important medical symptoms and preventive services during the COVID-19 pandemic due to concerns about not feeling safe going to the office. This current inadequate state of primary care is driven by several factors:
• An increasing shortage of primary care physicians
• With fewer doctors, those in practice are overextended
• Ongoing effects of the COVID-19 pandemic
• Clearly negative effects of health insurance participation in the relationship between primary care physicians and their patients
These factors result in poor quality of care, low patient satisfaction with access to primary care, and an ever-increasing cost of care.