America is facing a huge medical doctor (MD) shortage in the coming decades.  Even with a push by the Association of American Medical Colleges to enroll 3,000 more students per year, it still won’t be enough.  Primary care medical physicians are actually a dying breed.  It is especially rare to find a general practitioner MD in private practice these days.  There are several things going on here to make it impossible to find a regular country doc.

• Malpractice insurance is through the roof. Medical doctors have to do a lot of volume of patient visits just to cover the overhead.
• People expect to have their insurance pay for care now, but the insurance companies aren’t paying doctors well for well-visits. Again, it’s because of the insurance company’s and Medicare’s poor reimbursement practices that doctors are buried with paperwork while not getting paid well for routine visits.
• The insurance strong-hold on doctors is making things pretty stressful with all of the paperwork. This isn’t regular chart notes.  This paperwork is to justify the patient visit.  This takes more time, and this adds to the stress.  Once a doctor is done with this, then he must concentrate on his business, which adds another layer of stress for a guy or gal who needs to be an example of good health.
• Large hospitals are in charge of HMO insurance plans, and they would sooner send patients to their own in-house general practitioners than send them outside to an independent doc.
• General practice isn’t as much fun compared to the old days because people show up asking for the medications that they learned about on TV. There are fewer challenges in practice.  There is less interest of learning about wellness through general practitioners.
• After medical students finish their four years of medical school, it is part of their culture to go on to finish a residency to specialize in a specific area of care, like anesthesiology or cardiology.  These specialists are less likely to take you on without a referral, and their less likely to be in private practice. Adding another four years to college will double your yearly income thereafter.
• Private practice is a business risk.  Getting a job as a doctor in a hospital is easy.
• Getting a job in a hospital exposes the doctor to more opportunities to advance their career.
• Old doctors who are part of the old-school culture of starting their own practice are retiring, which is part of the natural attrition of the number of general practitioners. New docs aren’t taking their place.

I don’t know what can be done about this shortage.  Perhaps we will have to resign to the fact that we will have nurse practitioners making health care decisions for us instead of doctors.  I have another alternative, though.  At least for the neuromusculoskeletal system, you should see a chiropractor first, then see a specialist second. Chiropractors are portal of entry providers who work in autonomy.  We don’t require referrals.  We make our own diagnosis.  We aren’t under the management of a busy doctor, or worse, under the management of a big insurance company. We only have to answer to our patients, ourselves and the standard of care set by our peers.

Chiropractors are shown to reduce costs when included in the health care system as a whole, and we cost less to manage musculoskeletal care for back pain, neck pain, rib pain, sciatica and everything else in between.

Todd Lloyd, DC
Chiropractor in Santa Rosa, CA

From Bloomberg.com