"I already have a doctor I’m happy with."
One of the main obstacles to health reform has been the resistance of Americans who already have health insurance.  They are pretty satisfied with what they have and frightened that change can only hurt them.  The same is seen in Americans’ attitudes to the primary care shortage.  Most Americans with insurance have a primary care doctor that they are satisfied with.  Where’s the shortage and why should they care?  Why should we invest hundreds of millions of dollars into training more health workers when they already have a doctor they’re happy with?

The truth is that whether you are insured ore nor or have a doctor or not, the primary care shortage affects us all.    The most important affect is that of waiting times which have dramatically increased for all patients.  For example, a recent study showed that the wait times for a non-urgent appointment to see a family doctor were as high as 63 days in many cities.  Long waits extend physical and emotional pain, cause conditions to worsen, delay diagnosis and treatment, worsen outcomes, and cause some people to forgo care completely.   To worsen matters, many people who cannot get an appointment with their primary care provider in a timely manner resort to the Emergency Room where they drive up the cost of health care for us all and delay care for the critically ill.  With non-emergent patients unnecessarily clogging up the ER, the patients who truly need to be seen are neglected.

You may also think that you don’t need a primary care provider.   For example, you may have a cardiologist that you see regularly and she takes care of all your health needs.  Yet, a preponderance of evidence shows that those patients who see a primary care provider who coordinates all their care with specialists have better health outcomes and lower health bills than patients cared for exclusively by specialists.

A Practical Experiment
For those readers who may still be doubting, I’ll suggest a practical experiment.  Call your primary care physician’s office and tell the scheduler that your back has been hurting for a week and you would like to see your doctor.  My bet is that you won’t be able to get an appointment for at least a week if not longer.  Then ask the scheduler when you can schedule an appointment for an annual physical exam.   You’ll probably be given a date several months in the future.  Then tell the scheduler that a family member is considering being seen by your doctor as a new patient.  Is your doctor even taking new patients?  If you’re lucky enough to get a “yes”, ask when your relative can schedule an annual physical.

The Price Paid by Rural Americans
The situation is worse for the over 60 million Americans living in rural America; the primary care shortage is deeper in rural American than metropolitan America.  As part of the “hollowing out of the middle” the US has not invested enough in training primary care providers with an inclination to serve rural communities or in structuring payment systems that incentivize providers to work in rural areas.   A recent study in central Texas on insured patients showed that 25% of them had trouble getting to see a doctor in the last year.    The US relies on rural America for much of its food production and light industry yet rural America is on its own when it comes to their health.

The Coming Wave
If you don’t think there is a primary care provider shortage, just wait until the more than 40 million uninsured Americans finally get insurance and a title wave of previously unmet need lands on the primary health system.   In addition to their pent-up demand, the uninsured tend to be lower income than the insured and have worse health status than middle and upper income Americans of the same age.  Even without the addition of the newly insured, shortages of over 125,000 doctors are being predicted by 2025.  That number will worsen if demand for their services is increased.

So whether you have insurance or not, the primary care shortage affects you.  We need a rapid expansion in the training of all different types of primary care providers, including pediatricians, family practitioners, internal medicine specialists, nurse practitioners, and physician assistants.  Only then will we have enough hands to do the work.