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The Future of Primary Care for Baby Boomers

(Nancy Weber) -- It is anticipated that by 2010, 30,375 Howard County residents will be 65 years and older.  How many of these will have access to a primary care physician?

According to a recent county by county study by the National Association of Community Health Centers (NACHC) and the Robert Graham Center, at least one in five Americans are "medically disenfranchised" having inadequate access to primary care physicians in their area.  A recent report from the National Academy of Sciences noted that access to health care for the aging population is becoming a pressing issue; the number of providers able to care for this population will not be able to meet the increased need.

There are a number of factors creating the shortage of primary care physicians especially for adults covered by Medicare.  These include fewer medical students, fewer residency programs for primary care, school debt, reimbursement rates and physicians who are Baby Boomers will soon be retiring themselves.

Primary care physicians, comprised predominantly of internists and family medicine practitioners, are decreasing in numbers through retirement and with fewer physicians choosing primary care.  Recently, 44 medical schools and hospitals across the United States have dropped their primary care residency programs.  There are fewer students entering medical school and there has been a decline in the number of medical school graduates entering primary care since 1997. 

One reason for a decrease in primary care physicians is too little money for too much work. Median income for primary care doctors was $162,000 in 2004; the lowest of any physician type, according to a study by the Medical Group Management Association in Englewood, Colorado. Specialists earned a median of $297,000, with cardiologists and radiologists exceeding $400,000.  Many medical school students graduate with student loan debt of $145,000 - $300,000.

On average, primary care physicians' earnings are a half or a third of doctors in specialty care, yet their workdays are longer and their overhead is higher.  A large part of the overhead is paperwork due to insurance requirements and mandated pre-authorizations for referrals.  Another factor is the movement toward "Hospitalists".  These are physicians who are trained in internal medicine are opting to practice within hospitals as medical staff rather than establishing their own private practices. They are not burdened with high overhead costs; especially costs related to office staff and malpractice insurance.

The trend toward specialty care impacts cost and quality of care.  A recent American College of Physicians (ACP) study compared the American health care system with 12 other countries and found that all other countries had better medical outcomes than the United States.  The reason is that systems with primary care as the cornerstone are less expensive and have better quality of care.

Another factor is insurance reimbursement rates.  This is especially problematic for Medicare beneficiaries.  Nearly 1.3 million people covered by Medicare (3%) have difficulty finding a new primary care physician when they move due low Medicare reimbursement rates that are often below the actual cost of providing care, and the dwindling number of primary care physicians.

This scenario has begun to play out in Howard County.  Over the last four decades, the County has experienced rapid growth primarily through migration.  Older parents of residents relocate to this area to be closer to family and often need to find a new primary care physician.  Anecdotally, a number of primary care physicians in the community are no longer taking new Medicare patients because of low reimbursement rates and higher overhead.

Howard County residents who retire and relocate to another state may find a similar situation.  Nationally, a number of organizations including the American Association of Retired Persons (AARP), the National Association of Community Health Centers (NACHC) and American College of Medicine (ACP) are studying this crisis and working with the federal government to develop strategies to address the issue.  Hopefully, by 2011 when many Baby Boomers become eligible for Medicare, a solution will have been found.