‘I’m Shocked at How Diff icult This Has Been’
Health care access wasn’t something Lauren Roiko worried too much about until recently. When Roiko’s beloved primary care doctor left a local health care system, she recommended a few potential providers at the same clinic. Only one doctor on the list was taking new patients – after a yearlong wait.
Roiko, a 42-year-old special education teacher with several chronic health conditions, called every clinic within 30 minutes of her home in Cedarburg. No one in the health care system could fit her in sooner; she tried a second system but could not find a doctor. In a third, doctors were available but nowhere near her home. Months later, Roiko ended up settling for a nurse practitioner who couldn’t answer all of her health questions in the speedy 15-minute appointment. “I’m an easy person, and I’m shocked at how difficult this has been,” she says.
Roiko’s experience reflects a major problem impacting people in Milwaukee and beyond: More and more primary care providers
are leaving the medical field, forcing clinicians to treat more patients in less time – and, as a result, sometimes leaving patients with lessthan-stellar medical care or with no reliable care at all.
Studies show a long-term
relationship with a primary care doctor is an important factor affecting individual and public health.
Along with treating your present symptoms and conditions, PCPs help prevent future disease by ensuring you’re up to date on vaccines and screening you for signs of potentially serious medical issues. “Establishing and nurturing that relationship over the years is going to be one of the keys to having great health outcomes over the course of your life,” says Dr. Mark Lodes, chief medical officer of population health and medical education for Froedtert & the Medical College of Wisconsin.
So your health might suffer if your PCP can’t fit you in, if you’re stuck with one you don’t like or don’t want to open up to, if you feel rushed during visits or if you can’t find a PCP at all. For Roiko, the absence of a PCP caused plenty of unnecessary stress and anxiety. She also ran out of her daily mental health medication and couldn’t find anyone to refill it – even an urgent care clinic refused.
Amidst a national physician shortage, this kind of problem isn’t uncommon, and experts anticipate it’ll get worse. The American Association of Medical Colleges predicts physician demand will continue growing much faster than supply, and that 10 years from now, the U.S. will be short by as many as 48,000 primary care providers. “Patients end up bouncing around, going to urgent care, clogging emergency departments or just not getting medical care at all,” says Dr. Jesse Ehrenfeld, the Milwaukee-based president of the American Medical Association.
Some turnover is to be expected: Doctors retire, just like the rest of us. In the next five years, AAMC data show, 35% of the physician workforce will reach retirement age. Deeply embedded systemic problems drive physicians to leave the profession, too, by contributing to widespread burnout – an issue only intensified by the strains on the system caused by the pandemic. Ehrenfeld cites problems, including administrative inefficiencies (say, doctors forced to manage excessive paperwork on top of patient care) along with recent cuts to Medicare programs that negatively affect providers’ reimbursement.
As for the shortage of doctors in primary care specifically, the burden of medical school debt may be a factor. Many students start medical school with the intention of pursuing primary care, but pay tends to be better for specialty doctors.
Specialties are particularly appealing to medical students and residents (doctors in training) because of their student debt load. “This also means students don’t often choose to practice in underserved communities,” says Ehrenfeld. “They go to urban areas to take higher-paying jobs.”
A shortage of primary care training programs for medical school graduates is another major problem, as residents can provide patient care, too. Many residents also choose to stay near the location where they trained, says Dr. Sabrina Hofmeister, medical director of the Froedtert & MCW South Side Residency Program. Before Froedtert added its two programs, the Milwaukee metro area only had five primary family medicine programs, compared with dozens of options for specialty training. Two of those family programs are expected to close next year. Ultimately, fewer primary care doctors in training means fewer providers for patients in need.
All these problems add up, Ehrenfeld says, to unfairly affect doctors and the patients they care for. Fewer practicing doctors means existing ones see more patients, increasing already-high burnout rates and ultimately pushing even more providers to leave the profession.
Organizations like the AAMC and AMA are advocating for systemic change by lobbying for state and federal reforms to address the shortage – for example, opening more federally funded residency programs and improving Medicare reimbursement rates. Recognizing the crisis, many health care organizations are implementing programs to prevent doctor burnout or incentivize doctors to work in geographic areas of need (such as forgiveness of federally or state-funded med school student loans). But there’s no easy fix, and change will take time. “If there was a simple magic bullet, we would have done this decades ago,” says Ehrenfeld.
In the meantime, patients may need to be persistent in finding or advocating for reliable primary care. Lodes says medical systems should have measures in place to help: If your provider leaves the practice, for example, the clinic should provide you with as much notice as possible, help you find a new provider and ensure you don’t run out of medicine or miss important screenings. “Even if your provider is out, someone in the practice should be able to provide that service,” says Lodes.
If that’s not the case, you can contact your insurance provider to find out who’s in-network for your plan and accepting new patients, even if that means pivoting to another health care system, driving a bit farther than you’re used to, or seeing a nurse practitioner or physician assistant rather than an MD or DO.
Walk-in clinics and urgent care are also good resources to help fill in the gap until you can see a primary care provider, whether you need help for an existing problem, a medication refill or have a new symptom. But urgent care isn’t a long-term solution – your health will benefit if you stay the course to develop a relationship with a PCP. “These can be helpful in the interim,” says Ehrenfeld, “but they aren’t a replacement for primary care.”