Factors Contributing to Primary Care Physician Shortages
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Primary Care Physicians act as a first line of defense in US healthcare, providing advisory and preventive services, condition and chronic disease management, and treatment for everyday ailments. This role is critical in maintaining public health, raising information awareness about health issues, and supporting communities.
Yet, they continue to leave the industry in growing numbers. Meanwhile, fewer medical students are choosing to pursue careers in primary care, contributing to a fast-widening gap between physician demand and available providers.
Impacting Primary Care Numbers
Primary care or general practice physicians remain the first port of call for most Americans with any health issue, but there are many reasons why that relationship is strained with physicians under more pressure than ever.
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Fewer Number of Physicians
Reducing numbers of physicians and a growing number of patients puts this role under great stress. That’s one of the reasons why there are fewer active roles, exacerbated by growing numbers of older physicians retiring or working less hours, and fewer younger ones entering practice.
Medical trainees are typically seeking better-paid and more specialized roles, due to a lack of incentives, making the primary care role less attractive to these cohorts. And the greater interest in specialized roles means there are fewer residency courses or training positions available for those wanting to become primary care physicians. This vicious circle continues to impact both the medical professional and primary care facilities across the nation.
Rural Healthcare Delivery Issues
The problem is worse in rural areas where there are ongoing acute shortages of healthcare practices and physicians willing to work in them due to lower pay and reduced career opportunities. This creates longer waiting times, an increasingly unhappy waiting room, and a greater burden on primary care due to a lack of major facilities.
In the current political climate, some of the quarter of a million of foreign-born physicians might also be considering their roles. And in line with other countries, attempts to provide a dumbed-down service, like the introduction of GP’s health-care assistants, might see others considering moving out of primary care.
Physician Burnout Problems
Burnout is cited as a factor in many medical roles and other professions, but it is a factor in primary care as well, even though consumers may consider it one of the more relaxed medical roles available. This has exploded in the aftermath of COVID, the heavy politicalization of healthcare, and changing demographics that see a broader range of healthcare needs, including mental health, being met by fewer specialists.
Then there’s the pressure on physicians to keep patients out of hospital, adding even more pressure and complex care decisions to their workload, adding to burnout and stress.
Healthcare is Becoming Less Personal
Health policy and the complexity of technology, all lead to leaving less time for patient relations and understanding of their conditions. Health technology might support better outcomes but it makes healthcare less personal and leaves patients being passed around more staff.
From robots or tele-services that provide an AI triage service to automated testing systems and email patient booking services, it is easy for physicians to lose sight of their patients, and become less engaged in their care.
The growth in electronic health records (EHRs) and healthcare IT require learning new skills, and extensive data entry. Physicians can spend hours entering patient information into slow or complex systems, rather than focusing on direct care, adding further strain.
New Approaches to Treatment
Novel diseases (like SARS, Covid and whatever comes next) and conditions all add to the cost of training new primary care staff, and complicate the health landscape, adding to the pressure that physicians work under. And even when technology does help, many physicians still find themselves drowning in paperwork, which they take home, leading to further stress and tiredness.
Whatever the reasons, primary care physicians find themselves under unrelenting stresses, impacting their home and family lives, leading to ever-growing pressure to find another role or retire from practice. Doctors are also shy from seeking mental health support, creating a damaging cycle of willful ignorance or abuse to cope with their problems.
Trying to Cope with Stress
Seeking help is the first step in managing any ongoing stress problem, with a recent survey showing 44% of physicians had symptoms. They should seek some form of support or counselling from within or outside the profession. Plenty of options are available, but many medical practitioners feel it is a sign of weakness or likely to impact their career if they seek support.
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Lifestyle changes can also help, from doctors taking their full allocation of holiday and refusing to take on extra shifts. We provide plenty of career advice to ensure that all health workers can operate efficiently.
Then there are the simplest lifestyle choices like a healthier diet, with plenty of superfoods to promote physical and mental health, as well as drinking water to stay hydrated, maintaining overall health. In terms of wider lifestyle choices, physicians can take up yoga, pilates, tai chi or other classes to promote inner calm and wellbeing to cope with the stresses of their jobs.
Other opportunities to learn include coping-with-work-stress related courses, distressing social and team events, down to simple choices like finding a new hobby or social group to engage with outside of work.
Holistic Health Growth
Many types of business talk about culture, engagement and work-life balance. If a primary care practice is lagging behind in these areas a change of management approach can help improve the lives and workload of physicians and all staff.
A business transformation can improve the quality of patient care, streamline administrative workloads and identify areas where the practice needs to improve. Business transformation is common in many workplaces, but can apply to healthcare. It sees the alignment of business and health goals, which can include a better environment, through changed or new processes.
The evolving steps of a business transformation can see what changes work, and which need further refinement to build a happier, more effective care practice.
Staffing and Hiring Changes
Staff can also be encouraged to identify signs of stress and burnout, and offer advice on changes to improve that situation through a supportive culture. Many traditional doctors are opposed to such changes, but at a practice level, the changes can improve the business and health outcomes.
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Management can boost hiring efforts to attract fresh talent, with student loan forgiveness an attractive selling point to new hires, with profit shares for current physicians. They can hire support nurses and assistants to reduce the physician’s workload and encourage schemes like preventative care to reduce the number of critical cases.
Some of these improvements can come through better use of technology, but it needs to be appropriate for purpose, and not weighed down by a need to learn complex new systems or processes. Any training needs to be done in a dedicated manner, rather than on the job, with suitable help and support resources in place when a system goes live.
The Future of General Practice
However the working landscape changes for primary care physicians, there is no escaping the rise of technology. New physicians will be better placed to cope with the next-generation of medical IT systems, applications and hardware.
The rise of AI in medical use is already happening, with image scanners highly successful at detecting tumors on scans and creative innovative medicines. In general practice, AI virtual assistants are helping with patient triage and reducing the workload on physicians for common conditions.
AI back-end systems can also handle admin tasks like scheduling, billing, and more of the documentation in a practice to help reduce that workload. It won’t be long before a human-looking medical AI, with all of recorded medical history to refer to, will appear on-screen providing around 75% of patient healthcare needs.
The bot will talk and react like a human, and provide synthesized emotional reactions when appropriate and dealing with upsetting cases. Bots will also know when it is time to hand a case over to physicians for that essential layer of dignity, compassion or expert insight. This approach will leave physicians to cope with the more complex or borderline cases that require deeper knowledge and insights. At the same time, by the 2030s, robotics could threaten more roles, creating different stresses for physicians.
Telehealth is improving patient care, especially those with limited mobility, speeding the process of diagnosis and treatment. While the increase in remote and wearable monitoring systems mean doctors can get an early alert if there’s a patient issue.
At a societal level, the use of smart watches that can detect abnormal heart symptoms, alert medics to a fall and other conditions are all useful in broadly improving patient care. Their results can provide a clear picture of health conditions, from the simple like constant exposure to loud noise, to poor sleep patterns and weak blood/oxygen levels. Understanding the value of the technology will help primary care workers improve their results.
Technology will redefine Primary Care, there remains a strong role across society and the health system for physicians to diagnose, treat, and interact with patients. As these innovations continue to evolve, primary care practices can use them to improve patient outcomes and create a sustainable future for healthcare.
Primary Care Levels
The shortage of primary care physicians is just one of many growing medical crises, but it is the one that will have the greatest effect on patient care and outcomes. From elderly people losing their one trusted medical point of contact to patients falling through the cracks of a busy practice, it is up to all parties to mitigate the key and secondary factors driving this trend:
- A declining number of physicians
- Burnout among primary care workers
- Technology improving care but reducing interactions
- Changing approaches to patient care
- Doctors unwilling to seek mental health support
Individual health practices and the industry as a whole must reconsider their approach to working methods. For these reasons, despite their importance, more physicians will continue to leave the healthcare industry, while fewer medical students are opting for primary care careers, exacerbating an already significant workforce gap. Physicians themselves must take greater care of their own needs, while taking a more positive and pragmatic approach to delivering medicine in ways that meet patient needs in the years to come.