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FeedPrimary Concerns
Both patients and the medical community say they want more family doctors, but supply-and-demand isn’t working.
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Beneath the furor, misinformation and political partisanship surrounding our national healthcare debate, there lurks a threat greater than rising costs and perceived loss of rights: When you call to set an appointment with your “regular” doctor, will anybody answer the phone? 
Long ago, doctors stopped making house calls. Now, the general practitioner could be an endangered species. That may be especially true around these parts, where primary-care physicians cite a laundry list of career killers, including lower insurance payments and higher malpractice costs than in most other areas.
“It’s a perfect storm in Southeastern Pennsylvania,” says Dr. Lucy Hornstein, whose solo practice is based in Valley Forge, and whose blog “Musings of a Dinosaur” dispenses medical advice and sorely needed humor.
Bryn Mawr Hospital’s medical staff president doesn’t offer much reassurance, either. “There’s a brain drain in primary care out of the state and the city,” says Dr. John Hobson.
Hobson attributes the exodus largely to a “migration” from primary care to specialties and sub-specialties. “The average age of individual [primary-care] practitioners in the Main Line area is 55-plus. It should be 38,” he says.
The eye of Hornstein’s perfect storm for family doctors is their third-party reimbursement, which she says falls considerably below the rates paid elsewhere because “a couple of 800-pound gorillas dominate the market.”
Says Dr. Mitchell Kaminski, chairman of family medicine at Crozer-Chester Medical Center and a 2009 Top Doctor: “There’s an imbalance in the amounts of money put toward procedural things and how little, comparatively, is paid for comprehensive primary care.”
Apes and dinosaurs aside, the evolution of primary care (family medicine, general internal medicine and pediatrics) has been shaped by several trends not lost on the medical community or policymakers. The American Academy of Family Physicians estimates that its ranks must increase by more than 60 percent by 2020 to handle the spectrum of needs, including a burgeoning senior population. The American Medical Association forecasts a significant shortage of primary-care physicians in the decades to come if present conditions continue.
Shrinking inpatient work due to hospital or insurance restrictions further depresses income, say some PC doctors, while the sky-high cost of malpractice insurance premiums (Pennsylvania being one of the stiffest states) ratchets up expenses. It’s no wonder, then, that more and more newcomers opt for specialties, where the pay is more and the paperwork less.
“It’s harder to recruit primary-care physicians,” says Mark Schwartz, director of business development for Phoenixville Hospital. “Not as many are going into the field. It’s much more attractive to go into a specialty, with a year or two of extra training.”
