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The Primary-Care Conundrum
Where have all the doctors gone?
By Lindsey B. Koehler
October 2008

Used to be that you had your family doctor's phone number written down on the side of your refrigerator. When the baby got a high fever or Junior bumped his head a little too hard, you rang him up. He'd calm you down—and maybe tell you to c'mon into the office if it sounded like something he should check out.

Today, though, you'd be hard-pressed to find a primary-care doctor able to take a phone call personally, much less tell you to come in without a scheduled appointment. The fact is, medicine has changed over the past 20 years. Doctors aren't choosing primary care. Instead, they are selecting jobs that offer a better quality of life. The primary-care doctor—the original gatekeeper of a patient's health—has become one of the least desirable jobs a doc can choose.

And that's a huge problem for patients—and the medical system at large. "Most people really only need a primary-care doctor," says Dr. Jane Steiner, a Denver-area family-medicine practitioner. "We can take care of up to 90 percent of medical issues right here in our offices—and it's more economical for us to do so." But high demand, an expanding shortage of docs, low insurance reimbursement, and a consumer-driven desire to see a specialist first have made it difficult for many primary-care practitioners to stay afloat.

In Colorado, where more than 49 counties (out of 64) are federally designated Primary Care Health Professional Shortage Areas, the need for more primary-care docs is evident. Yet finding those doctors isn't easy. "We recently recruited another physician to our office," says Dr. Theresa Heble, whose Littleton-based family practice needed more physicians to serve the demand. "It took a long time to find someone who was even interested in coming to join a small practice."

Of course, it's not supposed to be that way. For generations, being a general-practice doctor was why people went into medicine. They wanted to have private practices; wanted to see families grow up. They yearned to be the health-care professional for strep throat, rashes, and pregnancies. They were the epicenter and encyclopedia of a family's health and health history.

But today, when our population needs primary care more than ever to manage the proliferation of chronic health issues like diabetes, heart disease, and chronic obstructive pulmonary disease, doctors are shunning tradition.

"We're headed toward the perfect storm," says Dr. Bill Wright, the executive medical director of the Colorado Permanente Medical Group. "In the next few years we're going to see a doubling of the population over 65, and they're all going to need access to primary care."

Of course, it's not just our aging population that needs a stable medical home. We all need someone to be looking after our health—and picking up the phone when we need him to.

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