Just got another medical appointment cancellation due to yet another family medicine practitioner disappearing. What is up with this? I had the same doctor for decades, then he retired a few years ago, and each one I’ve moved to since has disappeared within a few months. Nobody has made it a year yet. I can’t even remember them all, five at least.
Is there some common reason for this? Maybe we’re all moving to the Urgent Care model, not having a regular practitioner at all?
What state are you in? Some states are regulatiing the practice of medicine in way that is causing doctors to leave the state.
Medical specialists make more money than generalists. It’s a simple as that, or at least that’s part of the reason.
Have you looked any of them up? When you say they’re disappearing, are they moving/quitting/retiring? Or are they being hired (or their practice bought) by a larger medical group?
Maybe they are rotating to other localities. There’s a community clinic I know that is in a big system that does this. They have a group of doctors under contract and they do this rotation thing.
These would be young docs not in a practice or have their own.
I assume they can’t afford to get into one.
Ask if your clinic is in a big medical group and why the doctors keep leaving. It may simple as that.
The number of medical students selecting family practice increased again this year in the U.S., with a new record for students selecting family medicine residency programs in the national match.
Family Medicine National Resident Matching Program (NRMP) Results Analysis | AAFP.
So family practitioners don’t seem to be “disappearing”, though whether there will be enough to meet demand is another matter.
My clinic is one of the biggest in Northern California and when I asked, one of my doctors said they simply aren’t paid enough. It’s expensive to live in NorCal and, according to this doctor, wages are pretty much the same even in cheaper locations. So, many doctors decline positions in this area.
Optum West acquired my local medical system and destroyed it. Huge numbers of docs, including my PCP, have left.
I think that’s it in a nutshell. If you’re a cardiologist, you’re making specialist money which is considerably higher than your family practice general practitioner. More than 100k a year, according tot this report (it’s for 2023):
There’s also the increasingly onerous administrative tasks that doctors are required more and more to do as a consequence of the way EHRs and practice management software packages operate. Many doctors view their jobs as straight doctoring, and bitterly resent the actual logging of the data in the system, and many systems don’t let the support staff do certain tasks, because they’re diagnosis/treatment related.
My most recent PCP, retired last month, served most of his career as a cardiologist. He was also married to an MD (I don’t know if she used to have a specialty) and in their 60s they wanted to work only a partial schedule, so they took up general practice, working together in the same medical practice. They had been going to retire at some point, but the cost-cutting policies of that large medical practice hurried that along.
Before he retired he recommended a different, much smaller general/family practice in the same medical building. He also recommended researching all the doctors who were accepting new patients in that practice, and choosing one who is around 45 or 50. He said that by that age they are probably settled in pretty well to what they want to do, and they still have at least 15 or 20 years before they are likely to retire (all things being equal). Younger doctors are more likely to pick up their sticks and do something else, for a variety of reasons; older doctors may be too close to retirement. Since I’ve had two doctors retiring in the past three years, I’m going to try to follow his advice.
I’m going to give a third-party anecdote, as my brother is a MD, and is his wife. Because I asked him about this nearly 20 years ago.
First, my family is probably upper middle class in terms of wealth and paid for his undergraduate education completely, and helped (not 100%, but a good bit) with his higher education as well. But even so, there was a LOT of debt accumulated.
So, when he first began to look for professional employment, it was where the money is/was. A lot of young doctors (and lawyers) are drowning in debt, and are looking to that first.
Second, echoing @bump’s point, a lot of small family practices are the epitome of being your own boss, and ALSO having to do it all yourself. Between the requirements, the filings, the the fact that the more people you hire to do it for you (so you can, you know, see patients) the less money and/or time you personally have left. No, much easier to be part of a group/hospital/etc.
Another, related issue, is that by the time you’ve put in your years in your hospital et al, and paid off your debts, you find yourself thinking about going into personal practice, because said group/hospital keeps pushing you into ever more administrative work. But by this point, based on typical patterns, you now have kids, or even teens considering going into college, and suddenly money comes right back into the picture.
So by the time you may finally be as financially independent as you want, you’re late 50/early 60s, and you open up that little private practice you always wanted… or you’re ready to retire. Or one, leading directly into the other, because after being your own boss (back to my second point) and working extremely hard, it’s just not worth it anymore.
Everyone’s experience will of course be different, but that’s the condensed version as I’ve understood it from my brother, sister-in-law, and their reported comrades.
That’s funny that you should mention that; my experience is in healthcare IT for one of the country’s largest occupational health clinic chains. Our doctors would bitch about having to do anything other than the most strict doctoring type work, as if somehow it was beneath them, etc…
And then they’d turn around and tell us IT types how we should be doing our jobs, because apparently a medical degree grants you some sort of knowledge about how IT and computers work.
I’m a family medicine practitioner, employed by a large national groups and practicing strictly in the nursing home setting. Here’s what I’ve seen happen, at least in South Texas. A lot of independent practitioners have sold their practices to various large groups, whether that be the local hospital group or a big insurance company. Some of them stay on at a reduced schedule. I spoke with one of my colleagues earlier today in this situation, and this person’s case load is now reduced by 1/2, as they are now seeing only patients who have insurance with the big national insurance company that bought their practice. And that’s because this person is one of those people who enjoys the work and wouldn’t know what to do with themselves if they retired (they have more than enough money to do so). Not every doctor in that situation will do the same. Some of the ones that have enough money to retire do retire. Losing doctors who follow that path probably is the largest single contributing factor for why family medicine practices are disappearing. Others, like myself, have chosen career paths where we work exclusively with patients in a nursing home or hospital setting after having started out working in an outpatient setting. In my particular case I like the flexibility it affords. The patient’s are always at the facility, so I can adjust my schedule day by day and hour by hour if need be rather than being tied down to a specific schedule. I’m sure I’m not the only doctor who finds this flexibility appealing. Lastly, there’s the geographic distribution issue. Although I don’t have any first hand experience with other places, having practiced in South Texas my entire career, my guess is that there are strong disincentives to set up a practice in states with higher taxes. Just like with the national population in general, my guess is that there’s a net flow of doctors moving from places like California and New York to places like Florida and Texas.
My rant as a retired burnt out crotchety old white male family medicine physician follows, so be warned. Don’t look for coherence, and excuse the spittle on the screen.
@ParallelLines and @FlikTheBlue have already stated a lot of the pitfalls and problems we FM docs have, and that I’ve experienced directly. I’ve been a part of small private medical groups that got taken over by big corporations, and watched my control over my schedule and what sort of medicine I do shift from my hands to those of my managers. I watched my compensation depend on ‘production’ (as defined by my managers, not by my patients’ needs) and patient satisfaction surveys. I was told not to treat certain diagnoses that I was more than capable of handling but rather refer them to our own specialists who could bill more for their care.
All that made me shift to the public sector for the final 20 years of my career where I had more leeway in what sort of patients I saw and how I scheduled them, and I was paid hourly rather than based on what revenue I generated. But even there I couldn’t escape the burden of having to directly do so much order entry, administrative paperwork, and endless justification of the reasons for why I did what I did. BAD electronic medical record systems abound still, and many if not most primary care physicians are still having to take significantly MORE time doing charting via computer than we used to take doing in paper charts. Which would be ok if that resulted in better patient outcomes due to better data collection, but too many electronic record systems are not showing those positive outcomes.
We have to deal with non-compete clauses too. I saw one relatively small private practice group of Family Med docs who’d been in the area for well over 70 years get bought out by a large med conglomerate who, after a couple of years forced the older docs into retirement and let the less senior ones go because they thought they’d have higher earnings by hiring newly graduated physicians at lower guaranteed salaries. The disenfranchised physicians couldn’t practice within 50 miles of the community they’d spent decades in.
I’m glad I’m out, and if I had to do it over again, I’d not choose Family Medicine given the way it is today. I’m glad I did it when it was still fun, I’m glad I went into the public sector for the 2nd half of my career, but I had to retire for my mental health.
I still miss the joy of just dealing with and helping patients at times.
Here in Canada family doctors are in a severe shortage too, and we can’t blame insurance companies.
What I wonder (how applicable is this to the USA?) that Canada recently hit 40M population. So in about 2 decades, mainly due to immigration, population has expanded 25% or more. I haven’t read about the number of spots in medical schools increasing significantly, so a major factor of the problem seems to be number of graduates not keeping pace with population growth.
Plus, a lot of much older doctors - like mine - who were already approaching retirement decided the Covid shutdown was a good sign it was time to retire.
There are not. A large fraction of the primary care providing docs are retiring. The demand meanwhile is increasing. The uptick in those choosing to go into primary care doesn’t come close to denting that supply demand mismatch.
More even is that there are simply fewer and fewer of them left. Medicine is increasingly larger corporate groups. The compensation pool and thus payment is increasingly coupled to achieving population wide metrics and small groups cannot play in that space. Those entrepreneurial practice owning docs sell off or just close up now.
The new doctors are treated as, and consider themselves to be, employees. And employees are more likely to pick up and move for a slightly better deal than an owner is.
Hence the next part of supply and demand: spots need filling so very attractive offers are made to new hires. Better compensation for the amount of work than established docs get. (Less total pay often but they are not yet very efficient at what they do.) For two years usually. Then productivity becomes a bigger factor. Pay drops. Unless they work harder and more efficiently. So some of these docs move on to the next new job.
And yes the corporation is primarily motivated by profit more than community service. The lack of that group wide unified sense of a mission to do a greater good contributes to burnout and tilting the work/life balance farther and farther away from valuing work.
So nutshell:
Doctors aging out while demand increases and pipeline in not big enough or anywhere near as productive. And more newer docs moving from job to job far enough to not worry about non-compete clause issues compared to the old school practice owner mindset.
Exactly. In addition to what you mentioned and what I had already posted, in my area it’s usually the largest independent practices have survived. These are the doctors that have expanded to offer services like botox, vitamin injections, and other “med spa” type treatments. These doctors typically have several offices, most of them staffed by PAs and NPs who do the bulk of the everyday office visits. They focus their time on providing care to those paying out of pocket for those specialized med spa type services that the insurance companies and Medicare don’t consider medically necessary.
This is all consistent with the experiences I’ve been having. Now I’m wondering what to do about it.
I get the idea that having a regular doctor or practitioner is becoming a thing of the past. I have a pulmonologist who’s great, and a spine surgeon, and so forth – maybe I should focus on just working with them. And going to the Urgent Care.
Here’s a test case: I’ve had unexplained pain in my left flank for at least 10 years when I lean into anything such as a car bucket seat and have made a few small attempts to figure out what it is – my urologist looking for stones, my spine surgeon looking for slipped disks, my colorectal surgeon looking for bowel defects, et cetera. Nobody finds a smoking gun, and I keep positioning an off-center pillow in my car seat. Well, last fall I decided to make a bigger effort to get to the bottom of it, with my FNP, who got various imaging and blood studies done. After negative results at every turn she decided it was worth doing one abdominal MRI w/wo contrast as a final attempt, and if we came up empty we’d declare it wasn’t worth trying anything else and just accommodate the pain.
The final MRI showed signs of chronic pancreatitis, but nothing else interesting. I’ve heard this before, though this time it appeared more progressed. It’s an incidental finding inconsistent with my flank pain. So I have this judgement call to make – what do I do about this? I was supposed to have the follow up online visit this coming Monday but they cancelled because she’s gone. I’m finding references saying I should follow up with another MRI in a year, and if progression is slow, repeat every two years; these things have a somewhat elevated chance of becoming pancreatic cancer, which is actually pretty curable if detected early (it’s often a death sentence only because nobody notices until a hopelessly late stage). I guess I should figure out what specialty deals with pancreatitis and get an appointment. And, also, plan to just deal with the flank pain unless it changes (she had already said that was the strategy if the MRI didn’t find anything there).
Yeah here too. The entrepreneurial owners do the spa and “concierge” care bits, usually leveraging many Advanced Practice Providers. That’s not what our communities really need. FWIW psychiatrists seem to so far be exempt from the corporate medicine snowball too. But many just pay out of pocket.
I am also needing to pick a new primary doc. I think the basic idea of someone who has been in the practice five to ten years makes sense. Long enough that they are more likely to not jump ship. Young enough to last me a few decades.
Is it possible to do a “Northern Exposure” (TV show) type of practice? Just be a small town doctor? I get that is a TV show but I’d think small communities could benefit from a local doctor to take care of medical problems that do not need a hospital. I’d think it would be possible to get the local government to subsidize such a practice (e.g. pay for the space, pay for equipment like an x-ray machine, etc.)
(really asking)