Medical authorities are predicting a huge shortage of primary care physicians and specialists in the not-too-distant future, just as the population of older Americans is exploding. After losing her own doctor to retirement, journalist Judith Graham takes a broader look at the way medicine is changing. Kaiser Health News posted her article on the KHN website on October 12, 2021. The story also ran in the Washington Post.
I hadn’t expected the tears.
My primary care doctor and I were saying goodbye after nearly 30 years together.
“You are a kind and a good person,” he told me after the physical exam, as we wished each other good luck and good health.
“I trust you completely—and always have,” I told him, my eyes overflowing.
“That means so much to me,” he responded, bowing his head.
Will I ever have another relationship like the one with this physician, who took time to ask me how I was doing each time he saw me? Who knew me from my first months as a young mother, when my thyroid went haywire, and who since oversaw all my medical concerns, both large and small?
It feels like an essential lifeline is being severed. I’ll miss him dearly.
This isn’t my story alone; many people in their 50s, 60s and 70s are similarly undergoing this kind of wrenching transition. A decade from now, at least 40 percent of the physician workforce will be 65 or older, according to data from the Association of American Medical Colleges (AAMC). If significant numbers of doctors retire, as expected, physician shortages will swell. Earlier this year, the AAMC projected an unmet need for up to 55,200 primary care physicians and 86,700 specialists by 2033, amid the rapid growth of the [older] population.
Stress from the COVID pandemic has made the outlook even worse, at least in the near term. When the Physicians Foundation, a nonprofit research organization, surveyed 2,504 doctors in May and June, 61 percent reported “often experiencing” burnout associated with financial and emotional strain. Two percent said they had retired because of the pandemic; another 2 percent had closed their practices.
Twenty-three percent of the doctors surveyed said they’d like to retire during the next year.
When doctor-patient relationships end, the patient’s medical issues can be overlooked.
Baby boomers, like me, whose medical needs are intensifying even as their longtime doctors bow out of practice, are most likely to be affected.
“There’s a lot of benefit to having someone who’s known your medical history for a long time,” especially for older adults, said Janis Orlowski, MD, AAMC’s chief health care officer. When relationships with physicians are disrupted, medical issues that need attention can be overlooked, and people can become less engaged in their care, said Gary Price, MD, president of the Physicians Foundation.
My doctor, who’s survived two bouts of cancer, didn’t mention the pandemic during our recent visit. Instead, he told me he [was] turning 75 a week before he closed the practice at the end of October. Having practiced medicine for 52 years, 40 as a solo practitioner, “it’s time for me to spend more time with family,” he explained.
An intensely private man who’s averse to publicity, he didn’t want his name used for this article. I know I’m lucky to have had a doctor I could rely on with complete confidence for so long. Many people don’t have this privilege because of where they live, their insurance coverage, differences in professional competence and other factors.
With a skeletal staff—his wife is the office manager—my doctor has been responsible for 3,000 patients, many of them for decades. One woman sobbed miserably during a recent visit, saying she couldn’t imagine starting over with another physician, he told me.
At one point, when my thyroid levels were out of control, I saw my physician monthly. After my second pregnancy, when this problem recurred, I brought the baby and her toddler brother in a double stroller into the exam room. One or the other would often cry sympathetically when he drew my blood.
I remember once asking when a medical issue I was having—the flu? a sore throat?—would resolve. He pointed upward and said, “Only Hashem knows.” A deeply religious man, he wasn’t afraid to acknowledge the body’s mysteries or the limits of medical knowledge.
“Give it a few days and see if you get better,” he frequently advised me. “Call if you get worse.”
Older people often have trouble finding a new doctor who is accepting patients.
At each visit, my doctor would open a large folder and scribble notes by hand. My file is more than four inches thick. He never signed up for electronic medical records. He’s not monetizing his practice by selling it. For him, medicine was never about money.
“Do you know the profit margins this hospital makes?” he asked at our last visit, knowing my interest in health care policy and finance. “And how do you think they do it? They cut costs wherever they can and keep the nursing staff as small as possible.”
Before a physical exam, he’d tell a joke—a way to defuse tension and connect with a smile. “Do you know the one about …” he’d begin before placing his fingers on my throat (where the thyroid gland is located) and squeezing hard.
Which isn’t to say that my doctor was easygoing. He wasn’t. Once, he insisted I go to the emergency room after I returned from a long trip to South Asia with a very sore leg and strange pulsing sensations in my chest. An ultrasound was done and a blood clot, discovered.
The young doctors in the ER wanted to give me intravenous blood thinner and send me home with a prescription. My doctor would have nothing of it. I was to stay in the hospital overnight and be monitored every few hours, efficiency and financial considerations be damned. He was formidable and intransigent, and the younger physicians backed down.
At that last meeting, my doctor scribbled the names of two physicians on a small sheet of paper before we said our goodbyes. Both would take good care of me, he said. When I called, neither was accepting new patients. Often, I hear this from older friends: they can’t find physician practices that are taking new patients.
The transition to a new physician can be hard for patients and also for doctors.
Price, who’s 68, went through this when his family physician announced she was retiring and met with him in January to work out who might take over his care. Price was admitted into the practice of a younger physician with a good reputation only because he asked a medical colleague to intervene on his behalf. Even then, the first available appointment was in June.
Orlowski had a similar experience two years ago when searching for a new primary care doctor for her elderly parents. “Most of the practices I contacted weren’t accepting new patients,” she told me. It took six months to find a physician willing to see her parents—again, with the help of medical colleagues.
I’m lucky. A friend of mine has a physician daughter, part of an all-women medical practice at a nearby university hospital. One of her colleagues had openings and I got on her schedule in December. My friend’s daughter recommends her highly.
Still, it will mean starting over, with all the dislocation that entails. And these transitions are hard for patients and doctors alike.
Several weeks ago, I received a letter from my doctor, likely his last communication, which I read with a lump in my throat.
“To my beloved patients,” he wrote. “I feel so grateful for the opportunity to treat you and develop relationships with you and your families that I will always treasure. … I bid you all adieu. I hope and pray for your good health. I will miss each and every one of you and express to you my appreciation for so many wonderful years of doing what I love, caring for and helping people.”
Judith Graham writes a column on aging and health for Kaiser Health News, where she’s a contributing columnist. She also freelances for other publications. Earlier in her career, Judith contributed more than 80 pieces to the New York Times blog, The New Old Age. She was nominated for a Pulitzer Prize for a series on defective pacemakers and was part of a Chicago Tribune team that won a Pulitzer in 2001.