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The U.S. is notoriously limited in its healthcare spending, specifically for primary care. In 2022 alone, primary care accounted for only 5% of the healthcare budget, with Medicare and Medicaid being even less than that.
Compared to their peers in specialisation, primary care physicians earn a third less, at $195,000 annually. Which doesn’t make sense, considering how dependent this country is on primary care physicians to provide basic medical attention.
And primary care physicians are feeling the brunt. Not only is the shortage causing them to be overworked, but they aren’t justifiably compensated for their efforts. Today, let’s discuss why primary care physicians deserve better:
- Primary Care Physicians And The Struggle With Lower Salaries
- Why Primary Care Is Underfunded In The U.S.
- How The Physician Shortage Impacts Healthcare For All
Also read: Physician Career Satisfaction At An All-Time Low
Primary Care: Clocking Extra Hours For Nothing In Return?
For a country that has the highest healthcare budget in the world, the U.S. healthcare system is severely lacking, especially when you compare it to other high-income countries, according to the Commonwealth.
Physician dissatisfaction is at an all-time high, with primary care physicians at the forefront.
There is a clear disparity in primary care in the healthcare system, where a doctor’s efforts don’t reflect in their compensation.
This creates a taxing environment, leaving very few willing to put up with a crumbling healthcare infrastructure and zero investment in improving it.
And so, we see numbers dwindle in the primary care physician workforce, with it being the branch of medicine where the highest number of doctors choose to retire earlier or reduce work hours to tackle the pressure from a stress work environment.
But why are primary physicians so underpaid compared to other specialities? One of the biggest reasons could be the pay model itself.
The U.S. is the only high-income country in the world without universal healthcare, which means our primary care depends on a fee-for-service model.
Don’t miss out: Are Physicians Leaving America?
The more services a doctor provides or the higher-risk procedures they perform, the more they can earn. But the problem is, a primary care physician’s main job is to provide comprehensive care, with very few intensive services involved.
And so, they don’t earn nearly as much as, say, an orthopaedic surgeon, even if they see a higher volume of patients per week.
A system that incentivises procedures such as surgical intervention and tests tends to leave primary physicians behind when it comes to their reimbursement. Fee-for-service doesn’t account for the core practices of primary healthcare, which are time spent on complex patient care, including prevention, awareness, and chronic disease management.
And so, we see a decline in primary care physicians, with medical students feeling apprehensive about entering the primary care workforce. Why enter a field that won’t earn them enough to cover basics like their high student loans and also has a massive burnout issue, to boot?
Where is the Money Going?
The U.S. does not budget to improve healthcare as a whole; rather, the biggest chunk of it is consumed by high administrative costs and insurance policies.
30% of the budget is designated to paperwork such as coding, billing, and submissions. Ironically enough, a majority of administrative spending comes under ‘wasteful’ spending, especially in the U.S., and has continuously topped the list of reasons why physicians feel unhappy with their careers.
Also read: Average Physician Salaries In The U.S.
Then there are ambulatory services and hospital care costs, where the U.S. ranks the highest in the world.
Because not enough money is allocated to establishing primary care centres, patients are forced to turn to the more expensive routes of emergency care to receive basic medical attention, usually accruing thousands of dollars in medical debt, despite any health insurance.
Of course, a portion of the budget also goes to furthering graduate medical education. While that sounds good on paper, most residents aren’t choosing to work in primary care due to the abysmal work hours and the low pay.
This means the actual problem of a primary care physician shortage remains because community-based training is practically negligent when compared to other specialties.
If Primary Care Goes Down, So Does Healthcare
So, here’s the thing: if primary care physicians continue to be mistreated when it comes to job responsibilities and compensation, it will hurt both physician welfare and patient outcomes.
A study by the Commonwealth Fund once concluded that our healthcare system performed so terribly that it was ‘in a class of itself’. And that isn’t wrong, considering how the U.S. continuously ranks at the bottom when it comes to healthcare outcomes, accessibility, and affordability.
This will only get worse with the physician shortage, but specifically in primary care.
The Health Resources and Services Administration estimates that the U.S. will be facing a shortage of 87,000 primary care physicians who work full-time by 2037.
But we don’t need to look to the future to understand how dire this situation can be. Because, as of last year, there were a record 7500 areas with health professional shortages, with around 75 million residents left vulnerable.
Already, patients in the U.S. are less likely to visit physicians, and it’s even more likely that they simply don’t have the option. With 2.7 physicians per 1000 population, the U.S. has the lowest rate of practising physicians per capita.
Read more: Resident Physician Salaries
When patients can’t easily access primary care, it leads to statistics such as the country having the highest rate of residents with multiple chronic conditions or a high infant mortality rate.
Investing in primary care means we can not only improve life expectancy in the U.S. but also improve general healthcare outcomes and eventually even lower healthcare costs. That last one is important because one of the biggest barriers to accessing healthcare is the exorbitant costs attached to it.
But if that doesn’t happen, we can expect a steep rise in primary healthcare deserts and more primary care physicians leaving the workforce.
Image Credit: Marcelo Leal
