There’s been a big demand for primary care doctors in the past 10 years, and that need will only grow over the next decade. That’s according to new findings from the Congressional Budget Office(CBO).
The report, out last week, cites a rapidly aging population and an increase in the number of people who have health insurance as reasons for the growing demand. Lyndon Pryor, with the Louisville Urban League, says the impact of that demand is already being felt.
It’s common, Pryor says, for Louisville residents to visit the Urban League’s community health program with the complaint of not being able to see a doctor. He says they also hear complaints from people about long wait times for appointments and providers that can't help with chronic conditions.
“They end up at clinics or family health care centers — which are large scale providers — which are not assigned a particular doctor," says Pryor. "It helps a lot of our clients find primary care but it also means that you might not have the same continuity of care.”
Continuity of care refers to care over time. Ideally, a patient would have one medical professional who treats them for head colds or a bad cut, but also catches the early stages of a disease. That’s important because often a condition can be warded off if caught early, or even prevented.
So not having enough doctors means there will be fewer people who can see the same doctor continuously. According to the CBO report, there are a few things that could be done to meet the demand.
One of the recommendations is being used by Brent Wright, a doctor with the University of Louisville physicians and T.J. Samson Community Hospital in Glasgow, Kentucky. Wright and his team are using a new model to reach out to people in their homes to make primary care a bit more effective.
“Our team went to someone’s home and they didn’t have a ramp, and they were wheelchair bound,” Wright says.
That was impacting the person’s ability to get to the doctor. That patient eventually got a new wheel chair ramp, thanks to grant funds from the Health Service Resource Administration.
“People might be hesitant to bring that up or be ashamed or embarrassed," says Wright. "And when you reach out to people and you actually see their physical surroundings, you learn a lot very quickly. Basic health centers around those basic needs.”
That kind of new model makes Wright’s job as a primary care physician easier. Health care navigators help patients figure out what factors are affecting their health care — whether its access to fresh food, running water or employment.
While using resources more effectively could help with the increasing demand for more primary care physicians, so could creating more medical residency positions. Earning a medical degree doesn’t make a med student a doctor — they also have to apply for competitive residencies, paid for by the federal government, to work in a hospital.
And while there’s a push to create more residency positions, there’s no money in the pipeline for it. Pryor, with the Urban League, says while more spots would certainly help, it’d be more effective to focus efforts on primary care. For example, one way to help could be a program that helps repay the loans of students who go into primary care.
Pryor says it’d be even better if primary care residencies were focused on working with patients who are low-income and have the basic health challenges Wright talks about. Because not all doctors are equal.
“We’ve had a number of clients who have had issues with physicians who they feel were dismissive or condescending toward them based on socioeconomic status," Pryor says. "And that does not bode well for getting people who are in marginalized populations to really want to go to the doctor and be responsible to their health needs."
