There's a perfect storm on the horizon and it may surprise you.
Several factors are coming together to create a new challenge for anyone who values access to good health care at a reasonable price.
In brief, there's a shortage of primary care physicians and internists in the U.S. and it's destined to grow rapidly. A study appeared today in the Journal of the American Medical Association that suggests we'll be short 50,000 primary care doctors over the next 10 years.
That means that, assuming the average physician can oversee about 2,000 patients a year (this number varies depending on several variables),100 million people could find it virtually impossible to find a doctor within the next decade.
Add to that two additional factors: 76 million baby boomers, are reaching an age when their healthcare needs are destined to go up, and the Affordable Care Act will be providing healthcare coverage to more people than ever before.
On top of all that, many primary care physicians are frustrated because they tend to make less money than do specialists, like surgeons, cardiologists, orthopedists and others. They feel they have too many patients to see, day in and day out, and not enough time to provide the level of care they would like.
So an increasing number of family doctors are deciding to move to "concierge" or "wellness" plans, which claim to "put patients first to provide the highest level of personal care."
The other day, when I found myself frustrated with how difficult it was to get a routine lab test ordered for me or a call back by our doctor after phoning (cheerfully!) for four consecutive days, I remembered a physician in our area who came highly recommended. I phoned his office. The woman answering the phone told me that his practice was changing, and I should call an 800 number to find out more.
I phoned the number. The representative told me the physician had joined a concierge-type practice called MD VIP. In this case, I would have to pre-pay $1,800 and continue to pay that amount per year to be a patient in the practice. But there's a catch. There's no room now for new patients. I could only get on his waiting list.
Basically, to be a patient in a concierge-type practice, you essentially pay a retainer, or annual fee, typically something like $1,400 to $3,500, depending on the region where you live. For that, the physician agrees to accept only a limited number of patients, promises to answer your phone calls on the day you call, and give you same-day appointments, among other benefits. The retainer may pay for a comprehensive physical, but it doesn't apply to regular visits, lab tests or other charges. Those costs would still be billed to your insurance company or to MediCare, if you're 65 or older.
So I phoned another doctor who had been recommended to me. Her practice was full, and there was no waiting list.
I called a third doctor; he had already switched to a concierge-type practice and was accepting no more patients.
So here we are, on the road to a European-style two-tiered version of health care, with a shortage supporting the physicians' urge to create "VIP" practices.
In areas where there's already a shortage of primary care physicians, it's happening now.
What to do?
- Be ready to act like the CEO of your own body -- my focus here -- and stay on top of your own healthcare, your lab results, your medications and your screening needs.
- Be sure you know everything you can about your conditions, issues or major risk factors.
- Be sure to get and keep copies of any lab work, any surgery or procedure report.
- Talk with your physician about his or her plans to expand, reduce or change the practice. If you're thinking of changing doctors, it may be a good time to do so, if you can
- If you believe you may need to find a new physician, now or in the near future, don't hesitate to get on waiting lists now of physicians whose practices you hear are well run.
- Make sure your health plan includes the physicians you would be most interested in having monitor your care. If it doesn't, consider changing plans when you can.
- See whether your healthcare coverage or Health Savings Account might cover the concierge fee should you decide that's the best direction for you now.
How to Prepare for the Coming Physician Shortage
The Long Wait: How Physicians Explain Packed Waiting Rooms
Side by Side: Doctors' Notes are Yours to Read