Primary Care has Changed: Here’s What it Means for You

Things are different today at your doctor’s office. 

You may have noticed the last time you made an appointment for an illness or injury, instead of your primary care physician you were treated by a nurse practitioner (NP) or physician assistant (PA). 

Known as advanced practice clinicians (APCs) these providers are an integral part of the primary care team at many practices including South Shore Medical Center, working alongside physicians to provide primary, specialty, and long-term care for patients. 

And today, APCs are helping meet the growing demand for primary care amid an ongoing, nationwide shortage of primary care physicians (PCPs).

VIDEO: David Halle, MD, on Advanced Practice Clinicians' growing role at South Shore Medical Center

What’s behind the PCP shortage

This shortage of primary care physicians is not new. There has been a slow, steady digression away from the field, which has not seen any significant growth in decades and the shortage has become even more pronounced in recent years.

A 2020 study by the Association of American Medical Colleges (AAMC), showed that only 32% of U.S. physicians actively practice in a primary care specialty and the number has been declining for a decade. Family medicine residents from medical schools dropped from 77% in 1998 to just 45% in 2016.

Citing information from the report, Elation Health highlights some of the factors behind the declining primary care workforce:

• Wage disparities – primary care physicians’ salaries are as much as 30% lower than that of physicians practicing in subspecialties, and loan debt for graduating medical students is high and rising.
• Subspecialties may seem more prestigious and offer a better lifestyle than primary care.
• The distribution of primary care is uneven, with too few providers practicing in rural and low income urban areas, which also face access issues due to insurance barriers.
• Recruitment practices disproportionately steer new and aspiring physicians into non-primary care fields.
• Burnout for primary care physicians ranges from 14% to 60% with the most common predictor being the practice environment.
• Career decisions – primary care physicians are more likely to retire early or shift from patient care into administrative roles. A national survey conducted in March 2021, showed that 1 in 3 PCPs planned to leave primary care within 5 years.

The pandemic has played a role

The COVID-19 pandemic has exacerbated the problems for the primary care field.

When the pandemic hit in 2020, primary care was the first line of treatment. In the beginning, it was all about testing and we didn’t have enough supplies.

Healthcare providers were struggling to meet the immense need and fielding questions arising from the often-conflicting information coming from state and federal public health agencies.

Patients were frustrated and providers were overwhelmed and burned out. After two tough years of the pandemic and a lot of reflection, many providers left primary care by resignation or retirement.  Others cut back their hours, which has also reduced patient access to care.

New competitors in the primary care space

Several out-of-industry players including Amazon, CVS, Walgreens, Walmart and Google are becoming competitors in the field and impacting primary care delivery by:

• Acquiring physician practices (Amazon)
• Acquiring digital and/or home care assets (Amazon, Walgreens, Walmart Google)
• Building new primary care clinics (Walgreens, Walmart)
• Expanding clinical services at existing locations (CVS, Walgreens)
• Launching a direct care membership model (Amazon)
• Competing for talent (all five companies)

Launched in 2019, Walmart Health a primary and urgent health care clinic, has most of its locations in the southern U.S., but Amazon’s One Medical and Walgreens’ VillageMD have locations in greater Boston and on the South Shore. 

Located inside Walgreens locations, VillageMD clinic patients conveniently become pharmacy and store customers following their office visit.  This keeps the overhead low and allows VillageMD offer larger salaries to recruit primary care providers away from other practices.

CVS, which already has healthcare industry connections through insurer Aetna, pharmacy benefits manager Caremark and its Minute Clinic urgent care locations, has also announced plans to get into the market by acquiring or taking a stake in a primary care company.

What South Shore Medical Center is doing to address the problem

With so much disruption to the primary care landscape, South Shore Medical Center is taking several steps to respond to the changes through ongoing recruitment efforts, promoting our APCs to PCP roles, and temporarily putting a pause on accepting new patients.

Like practices across the country, we are actively recruiting to bring in additional primary care providers. It’s a challenging process because there are openings everywhere and fewer people entering the field.

According to the American Academy of Family Physicians (AAFP) only 1 in 8 medical school graduates chooses to enter a family medicine residency each year.

Massachusetts Legislation passed five years ago allows both nurse practitioners and physician assistants in a primary care setting to expand their roles as primary care providers with their own patient panels.

Having ACPs as PCPs has eased the strain on primary care practices, led to a better patient experience and helped with both the quantity and quality of patient access. South Shore Medical Center now has seven APCs as PCPs.

Taking a pause on accepting new patients will allow us to continue to meet the healthcare needs of our current patients and support our staff during this very challenging time. Our goal is to reopen our provider panels to new patients as soon as possible.

David A. Halle, MD is Medical Director of Ambulatory Care at South Shore Medical Center. Learn more about primary care at South Shore Health.