As the debate on overhauling the nation’s health-care system exploded into partisan squabbling this week, virtually everyone still agreed on one point: There are not enough primary-care doctors to meet current needs, and providing health insurance to 46 million more people would threaten to overwhelm the system.
Old doctor's can't retire
At age 81, Dr. Kenneth H. Spady admits he’s finally ready to retire from his small town hospital in Everson, WA. Almost. After nearly 53 years in practice, at least 1,500 babies and more than 260,000 office visits, the sole medical doctor in this town of 2,100 figures it’s time to plan for the future. “I realize that sooner or later, something may happen,” said the soft-spoken physician who still rises at 5 a.m. and puts in 10-hour days in his Main Street exam rooms.
But Spady can’t hang up his stethoscope just yet.
After more than two years of trying, and several close recruiting calls, there’s still no one to take his place in this rural community 100 miles north of Seattle, where the nation’s shortage of primary care doctors has landed squarely at Spady’s office door.
“We’ve probably trotted eight or nine people through here,” said Dr. David A. Lynch, president of the Whatcom County Medical Society, which is helping conduct the search. “At this point, we have not been able to get a doctor to commit.”
As the nation’s debate about overhauling health care heats up, one truth remains undisputed: There are not enough general care doctors to meet current needs, let alone the demands of some 46 million uninsured, who threaten to swamp the system.
It’s a problem growing worse in Everson and across the country, where more aging doctors are finding they can’t retire. In the U.S., there are at least 4,500 primary care doctors older than 75, according to figures from the Physicians Masterfile database maintained by the American Medical Association. Overall, there are about 270,000 doctors practicing primary care, which includes family, general medicine and internal medicine.
Younger doctors choose specialties
Fifty years ago, half of the nation’s doctors practiced what has come to be known as primary care. Today, almost 70 percent of doctors work in higher-paid specialties, driven in part by medical school debts that can reach $200,000.
As younger doctors increasingly choose the better pay and balanced lifestyle promised by specialty practice, older doctors, especially in poor and rural areas, are working longer, reluctant to abandon their clients — but unable to find new care for them.
“Most of them would like to fade out, but they have an obligation,” said Dr. Joseph W. Stubbs, president of the American College of Physicians. “The issue is that there is not enough primary care because there are not enough medical students going into primary care.”
For patients, that translates into long waits, long drives, or, in worst cases, postponed care that eventually lands them in the emergency room.
Nearly 50 years ago, half of the doctors in the U.S. were general practitioners. Now, they make up less than a third of the physician workforce, according to studies by the American Academy of Family Physicians. Between 1997 and 2005, the number of medical graduates going into primary care fell by half, and fewer than one in five new graduates now say they intend to pursue the practice, the AAFP notes.
If current trends continue, the U.S. will be short by about 125,000 family care doctors by 2020, according to Dr. Ted Epperly, president of the AAFP board. He estimated that the U.S. needs between 40 percent and 50 percent more family practice doctors than the nearly 100,000 working now.
“The pipeline of family physicians has dried up,” said Epperly, who’s hopeful that health care reform will help correct the problem.
It takes six years to educate a nurse practitioner and a dozen years to produce a doctor. Even if Medicare funding for residency programs is increased, if medical schools increase their enrollments by the 30 percent recommended by the Association of American Medical Colleges and if financial incentives to enter primary care are put in place, it will take years to build the health-care system into the new model.
Do you think the system can be fixed in time?
