A Golden Opportunity in Primary Care

It isn't often that chiropractic has an opportunity to significantly grow its market share. We are usually fighting to keep what we have, battling with managed care, third-party payers and other health care professions. However, recent survey findings suggest we will soon be faced with a situation that could have a huge impact on health care and the chiropractic profession for decades to come.

A recent survey conducted by the Physicians' Foundation demonstrates "widespread frustration and concern among primary care physicians nationwide, which could lead to a dramatic decrease in practicing doctors in the near future."¹ In conducting the survey, the foundation attempted to measure how primary care medical doctors "feel about the state of their profession" through "one of the largest and most comprehensive physician surveys ever conducted in the United States."

Survey responses were "provided by approximately 12,000 physicians nationwide that included more than 800,000 data points - as well as through written comments by more than 4,000 physicians."² What the survey revealed apparently startled the foundation, although it may not be all that shocking to you:

• 11 percent of physicians said they plan to retire in the next one tothree years (35,000-plus MDs, ifyou extrapolate survey findings).
• More than 13 percent said they plan to seek a job in a nonclinical health care setting, which would remove them from active patient care (41,000-plus MDs).
• More than 10 percent said they would seek a job unrelated to health care (almost 32,000 MDs).
• 14 percent said they will cut backon the number of patients seen or work part-time (44,000-plus MDs).³

To summarize, that's more than 108,000 primary care physicians who are planning to stop seeing patients over the next three years - more than one-third of all primary care MDs currently in practice - and another 44,000 who are planning to see fewer patients and/or work less. Are you surprised by these findings? Before you decide, consider the perspective these doctors seem to have regarding their current situation:

• 65.86 percent find the practice of medicine either "less satisfying" or "unsatisfying."
• 22.39 percent said their practicesare "break even."
• Just over 12 percent said theirpractices are "unprofitable."
• Less than one in five (17.5 percent) rated their practices as "healthy and profitable."
• The majority (76.29 percent) said their practices are at "full capacity" or that they are "overextended and overworked."
• 42 percent rated the professional morale of their colleagues as "very low" or "poor."
• 60 percent would not recommend medicine as a career to their children or other young people.

As the son and grandson of doctors of chiropractic, my life began with the concept that for the vast majority of ailments, a DC was the only health care provider you needed to see. True, there were times that I went to see a medical doctor (mostly for sutures), but for everything else, my dad was the only doctor I saw. Back then, in the state of California, there were both chiropractic hospitals and osteopathic hospitals. I was born in 1955 in an osteopathic hospital in Salinas because the nearest chiropractic hospital was just too far away.

Given the potential dramatic decline in the number of and accessibility to primary care physicians, this may be a good time for chiropractors to consider their role in primary care. It is important to note that "the number of U.S. medical school graduates selecting family practice residencies has declined in recent years," according to the survey.

The current and future primary care physician shortage is real. How our profession reacts to this situation is up to each individual doctor. There is obvious potential for the growth of chiropractic, but it will likely require us to change our focus while maintaining our chiropractic philosophy.

References

1. National Survey Finds Numerous Problems Facing Primary Care Doctors, Predicts Escalating Shortage Ahead. Nov. 18, 2008. www.physiciansfoundations.org/news/news_show.htm?doc_id=728872.
2. The Physicians' Perspective: Medical Practice in 2008 - Executive Summary. www.physiciansfoundations.org/usr_doc/Executive_Summary_for_Website.pdf.
3. The Physicians' Perspective: Medical Practice in 2008 - Survey Summary & Analysis. www.physiciansfoundations.org/usr_doc/PF_Report_Final.pdf.