By Julia DeLuca, SWHR Communications Intern
Do you recognize this experience? You call to book your annual physical at your primary care provider’s (PCP) office, only to find that the next available appointment is six months away. You take the appointment and arrive at the office a few months later. You wait until a nurse escorts you to an exam room, sometimes past your original appointment time. Once in the room, you answer some questions, and they ask you to wait for the doctor. When your PCP comes in many minutes later, maybe a little out of breath, they apologize for the wait and launch into a series of rapid-fire questions. Before you have time to answer their questions in detail or perhaps bring up a reoccurring symptom you’ve been tracking, the questions cease, and your doctor is due to see their next patient.
PCPs play a pivotal role in women’s health and the health care landscape at large, but primary care practices across the United States are experiencing physician shortages, causing longer appointment wait times and less time with a doctor.
The Importance of PCPs
Often the first point of contact in patient care, PCPs are essential for preventative care, early detection and treatment of diseases, and chronic disease management. They can also build lasting relationships with their patients, at times treating the same patients for years.
Additionally, PCPs are central to care coordination between specialists and other providers. These physicians frequently refer patients to a specialist and can be considered stewards for specialized care. Some insurance plans, like Health Maintenance Organizations (HMOs), even require that patients see their PCP for a referral before they can see a specialist, making the PCP’s role central to care coordination (KFF).
PCPs have also been found to increase life spans and lower health care costs. A 2015 study published in JAMA Internal Medicine found that adding 10 PCPs to a population of 100,000 people was associated with a 51.5 day increase in life expectancy. According to a 2022 study, patients experienced significantly reduced health care costs and better patient outcomes when they visited their PCP.
Despite the valuable role PCPs hold in health care, today, many younger Americans are relying more on advice from family, friends, and social media over that of a medical professional (Axios). In particular, Generation Z (those born between 1997 and 2012) tends to be more distrusting of the medical field than older Americans (Fortune). As a result, younger Americans might forgo that medical expertise in favor of another source—especially if it is harder to see a PCP. Beyond younger Americans, other individuals who may be less likely to seek out PCP appointments are those who may be serving as formal or informal caregivers for someone else (about 60% of unpaid caregivers are women, according to PBS); those who are already managing care across several specialists (studies show women are responsible for about 80% of their family’s medical decisions); and uninsured or under insured individuals (in 2023, 25.3 million people ages 0-64 were uninsured in the United States, according to KFF).
PCPs Role in Women’s Health
PCPs are essential to women’s health. According to a study assessing data between 2000 and 2015, on average, more women went to PCPs over obstetrician-gynecologists (OB-GYNs). Another research article from 2016 published in the Journal of Women’s Health found that among women ages 45-64 years old, patients “were substantially more likely to obtain care exclusively with family physicians or general internists than of OB-GYNs physicians.” This trend can be attributed to the shortage of OB-GYNs in the United States—another care gap that deserves deep attention and specific solutions. In rural areas, women tend to see PCPs more than OB-GYNs because there are often less specialist physicians in these areas—in 2018, over half of rural county hospitals in the United States did not have obstetric services (U.S. Government Accountability Office). Additionally, many rural patients rely on Medicaid, which doesn’t always cover obstetric services.
Beyond reproductive health, PCPs are essential for addressing other conditions that disproportionately impact women. PCPs offer important preventative services such as lipid testing for heart conditions and cervical and breast cancer screenings. A 2022 research brief found that 2.8% of OB-GYN preventative visits included lipid testing compared to 30.3% of generalist preventative visits. Another research article from the Journal of Women’s Health found that in areas with more PCPs, there was better utilization of preventative breast cancer services.
As the first point of contact, PCPs are positioned to provide care coordination to address women’s holistic health. Health conditions such as autoimmune diseases and Alzheimer’s disease disproportionately impact women and require treatment for different parts of the body. For instance, a person with lupus may require a team of specialists—a rheumatologist, cardiologist, mental health professional, neurologist, hematologist, dermatologist, nephrologist, pulmonologist, pain specialist, and/or others. The PCP plays a central role in treating the entire patient.
Reasons for PCP Shortages
In the United States, 76 million people live in primary care deserts, and the shortage is only expected to worsen, according to the Health Resources and Services Administration. A 2024 analysis by the National Center for Health Workforce projects that the United States will experience a shortage of 87,150 full-time equivalent PCPs by 2037. The Association of American Medical Colleges (AAMC) made a similar estimate, projecting a shortage of 86,000 physicians by 2036. As a result, most PCPs cannot take on new patients and must pack their schedule with appointments to provide care for their current patients.
There are many reasons for this physician shortage—a growing aging population in the United States, physician burnout, and comparably lower compensation for PCPs are some of the most notable. The AAMC estimates that the U.S. population will grow by 10.6% from 2019 to 2034, with a 42.4% increase in those 65 and older. With a geriatrician shortage and longer patient life spans, PCPs will have more patients to care for. Additionally, the PCP workforce itself is aging. Out of active physicians in the United States, more than two out of five will be 65 or older by 2031 (AAMC). With a growing number of doctors approaching retirement, these physician shortages will continue to worsen.
Given the growing stress on primary care practices, physician burnout is becoming increasingly common—in 2024, more than half of PCPs reported feeling burnout (National Center for Health Workforce). This exhaustion is exacerbated as the shortage worsens.
Finally, primary care is one of the lowest paid physician fields. According to KFF Health News, increased compensation is essential to addressing the PCP shortage, as many specialists earned as much as twice the salary of PCPs in 2023.
A Healthier Future
Given the importance of PCPs and the growing physician shortage, new approaches are emerging that aim to provide high quality, accessible care.
One approach that is becoming increasingly popular is concierge medicine. Concierge medicine is a “business model in which a doctor charges patients a monthly or annual membership fee – even as the patients continue paying insurance premiums, copays, and deductibles. In exchange for the membership fee, doctors limit their number of patients” (KFF). This model allows doctors to provide more focused care since they are not overwhelmed by patient numbers; however, limiting the number of patients in the practice worsens the pressure put on traditional practice models. Concierge medicine is also significantly more expensive, adding separate annual fees of $1,000 to $50,000 to existing insurance rates (KFF). Concierge medicine is inaccessible for many populations that cannot afford the fees or for patients who are located far from these practices.
Another possible approach is expanding telehealth in primary care practices. During the COVID-19 pandemic, telehealth became essential to health care, as patients were restricted from in-office visits. A 2022 study provides perspectives from PCPs on how telehealth impacted their work—the physicians identified several benefits to using telehealth including reduced social and personal barriers to care, expanded access, easier follow-up care, and quicker specialist referrals. Also, there is some evidence that suggests that smaller primary care practices with fewer resources receive less Medicaid revenue. Adjusting policies to provide sufficient Medicaid reimbursements for PCPs could help them care for more patients relying on these insurance policies.
To effectively address the PCP shortage, support is needed across the entire health care continuum: generating more medical school interest in the field; addressing the cost of medical school, including loan debt and debt repayment relief; adjusting compensation rates; optimizing care practices to reduce the burden on individual providers; reducing administrative burdens; providing sufficient Medicaid reimbursements for PCPs, especially for smaller practices; and more. The AAMC provides some of these examples and advocates for a multipronged approach across federal, academic, clinical, and public support.
Positive care outcomes start with health care providers and ensuring they have the support necessary to do their jobs. The Society for Women’s Health Research is committed to supporting health care providers across specialties to ensure they can continue to provide the best care possible to patients across the lifespan.