The coming crisis in American primary healthcare

Over the past several years, there has been a growing shortage of physicians in this country, especially in primary care. A new report by the Association of American Medical Colleges suggests that the shortage will only worsen in the coming years, in large part because of physician burnout.

A stronger claim could be made that just the opposite would happen.

“The system is grinding us,” said one of the doctors interviewed for the Kaiser Health News article. “It’s grinding good docs and providers out of existence.”

The article noted that burnout is increasingly identified as a major problem facing medicine. Four in 10 physicians report feelings of burnout, according to a 2019 Medscape report. And the physician suicide rate is more than double that of the general population.

In most cases, those barriers were erected by private insurance companies. Among them are the ever-increasing requirement that doctors must get “prior authorization” from insurers before treating their patients, trouble making patient referrals and “endless clicking on electronic medical records.”

Researchers studying physician burnout recently began to apply that term to health care. They concluded that moral injury was an appropriate term to describe the root cause of physicians’ anguish: Physicians know how best to care for their patients but are blocked from doing so by systemic barriers related to the business side of health care.

Physician burnout has reached such proportions among American doctors that researchers are now using a term that comes from war: “moral injury.” As Kaiser Health News reported in February, moral injury was first used to explain why military veterans were not responding to standard treatment for post-traumatic stress disorder. Moral injury, as defined by researchers from veterans hospitals, refers to the emotional, physical and spiritual harm that people feel after “perpetrating, failing to prevent, or bearing witness to acts that transgress deeply held moral beliefs and expectations.”

As the supply of doctors continues to shrink we can only expect we will fall even further behind other developed countries in both doctors per 1,000 population and the number of physician visits per year in the future.

Not only that, but Canadians visit their doctors an average of 6.8 times a year, compared to four times a year in the United States. Germans go to the doctor more than twice as often as we do–9.9 times a year on average.

We even perform worse than Canada, a country that reform opponents often cite as a place where doctors are so unhappy they are packing up and moving to the U.S. The truth is that Canada, with 2.7 doctors per 1,000 residents, actually has slightly more doctors available to treat patients than we do. And in Norway, another country with a single-payer system, there are 4.8 doctors per 1,000 people.

According to a recent analysis by the Commonwealth Fund, which monitors the performance of health care systems around the world, there are 2.6 physicians per 1,000 people in the United States–way below the 3.5 per 1,000 average of the 37 countries that comprise the Organization for Economic Cooperation and Development.

The U.S. has already fallen far behind other rich countries when it comes in the number of physicians per 1,000 residents. While the expected shortfall can be explained in part because of changing demographics, the report says a big problem is the fact that more and more physicians are retiring early–a trend that likely will accelerate–because of burnout.

By 2033, the report found, the shortage of physicians is expected to range from 54,100 to 139,000 with the shortage being most pronounced among primary care doctors.  (Tarbell 7/1/2020).


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