Unlike other wealthy countries, the United States has a low ratio of primary care physicians relative to medical specialists. Currently, only one in three physicians practice primary care, and only one in six medical graduates chooses primary care. When you consider that primary care visits account for 55 percent of the 1 billion physician office visits each year, and that the Patient Protection and Affordable Care Act (ACA) could generate an additional 25 million primary care visits annually, one begins to see an already stressed system being pushed to the brink.
One way to measure the adequacy of primary care access is by availability of obtaining a doctor’s appointment when ill. Although we traditionally have criticized other countries for their long queues in receiving care, there is emerging evidence that long waits for primary care is becoming the norm in the U.S. According to a 2013 study by the Commonwealth Fund, 26 percent of 2,000 Americans surveyed said they waited six days or more for a doctor’s appointment when they were sick or needed care. This is just barely better than Canada (33 percent) and much worse than Britain (16 percent).
Physicians feel the pinch in time and money in this primary care bottleneck. A primary care physician with a panel of 2,000 patients would need to spend an estimated 17.4 hours per day in order to provide recommended acute, chronic and preventive care to their patients. In terms of physician work per hour, Medicare pays almost four times as much for a screening colonoscopy as it does for a complicated primary care office visit. This combination of patient demand alongside a reimbursement system that undervalues primary care care has led some physicians to seek a different kind of practice style. Enter “direct primary care.”