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Is the doctor In? Why it’s increasingly difficult to get an appointment

By Kristin Emery 5 min read
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Dr. Amy Crawford-Faucher

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Getting a doctor’s appointment for an urgent issue like the flu or COVID may not be a problem these days, but anyone trying to become established as a new patient with a family doctor may be in for a long wait.

The United States is facing a shortage of primary care physicians (PCPs), which is forecast to grow worse in the future. The Association of American Medical Colleges (AAMC) predicts the United States will have a shortfall of between 17,000 and 48,000 primary care physicians in the next decade. The American population is growing older, and Pennsylvania ranks fifth in the U.S. in size of its older adult population. As people age, they demand more healthcare resources.

Not only are patients getting older, but so are the doctors. That same AAMC report shows 40% of active U.S. physicians are nearing retirement age. To make matters worse, fewer young people are going into family medicine and new medical students are increasingly choosing specialties other than primary care.

PCPs average less pay than specialists, and lower insurance reimbursement amounts mean PCPs must see more patients or work longer hours to earn their money. That leads to burnout and, on top of the fatigue many cite from the COVID-19 pandemic, has led some doctors to leave the field or retire.

Local health systems say while they’re not experiencing a major PCP shortage, they are seeing changes.

“We have pockets in our footprint where we don’t have enough primary care clinicians, and it’s been a combination of retirees and physician age,” says Dr. Amy Crawford-Faucher, a family medicine physician and vice chair of the Allegheny Health Network (AHN) Primary Care Institute. “If you are in a more rural area and have two or three physicians retire at the same time, then that’s a gap that those patients are feeling and it’s sometimes a little harder to recruit physicians for rural communities.”

She also points out the difficulty patients can sometimes have trying to get established with a new doctor in this age of large health organizations and automation.

“In the olden days, you would call the office and the person at the front desk answers and can fit you in, right? Now, it’s a little bit harder because health organizations are large. They’ve got more centralized scheduling. It’s harder to have that personal touch.”

Washington Health System (WHS) says overall it is not experiencing extreme wait times for new primary care physician patients.

“It really varies by the office and the provider,” says Stephanie Wagoner, WHS Manager of Marketing and Community Relations. “If a patient is adamant about seeing a specific provider, which is often the case, they may have a longer wait time for new patient appointments. If the patient is willing to establish with any of our practices and see any provider available to get in, they may only have a three- to- four-week wait period.”

She says WHS does have a physician referral line local patients can call and ask to be connected with a PCP or specialty office. “On this call, they can ask which offices are accepting patients within the shorter time frame if they are in need of a quicker appointment.”

Finding solutions

Medical schools and health-care systems across the country are recruiting students for primary care, offering specialized PCP programs and increasing incentives such as scholarships. “I think that if you fix primary care, a lot of other things will fix themselves,” Crawford-Faucher adds. “Part of that issue with the shortage of specialists is not necessarily a shortage but patients who are going to the specialist for things that really could have been handled by comprehensive primary care.”

Both AHN and WHS focus on training PCPs and retaining them locally.

“Another great thing about our health system is we are a teaching facility,” says WHS’ Wagoner. “With our Family Medicine Residency program, we often hire our graduates to stay and fill some of the open PCP positions here in our health system.”

AHN has two family medicine residencies and tries to keep its graduates at home. “We hired six of our eight graduates this past July to stay within AHN, which is wonderful,” said Crawford-Faucher. “I think health systems that do a good job training comprehensive primary care and other specialists and can keep them in the system is one way to help regenerate and grow.”

The AHN Primary Care Institute is focusing on a new approach called the Extended Care Team. “We have in all of our primary care offices an embedded behavioral health specialist, a registered dietitian, a clinical pharmacist and social worker that cover issues that are either complicating or are a part of medical illness and things that I’m not a specialist in,” says Crawford-Faucher. If the primary care doctor is unable to see a patient, another member of the team may step in depending on the issue. For example, a dietitian may meet with a diabetic patient about nutrition rather than the PCP talking to him or her about dietary needs.

“When you work as a highly functioning team together, they’re still my patient,” she says. “It may not be all with me, but we’re accomplishing the same thing. I tell my residents primary care is a team sport these days. That’s how you can see more people and still give high-quality care.”

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