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The Danger of Our "Crisis Culture"


We live in a "crisis culture" -- the financial crisis, the energy crisis, the subprime-mortgage crisis. By calling every upheaval a crisis, the word gets watered down to the point of meaninglessness. Here's a real impending crisis: The primary care crisis. The profession of primary care physician in this country is dying. Fast. Physicians must find a leader who can articulate the serious repercussions of a growing primary care shortage. Otherwise, it will simply become the next crisis of the times.

We live in a “crisis culture.” Our current economic difficulties aren’t a “slowdown,” they’re a “financial crisis.” The need to find renewable sources of power is the “energy crisis.” And the industry-wide lending practices that led to near financial collapse are the “subprime-mortgage crisis.”

The problem with crisis-mode is that calling everything a crisis waters the word down to the point of meaninglessness. The dictionary defines a crisis as: “An unstable condition, as in political, social, or economic affairs, involving an impending abrupt or decisive change.” Some in the media seem to define it as anything that will pull in viewers.

The Haiti earthquake was a crisis. The Gulf oil spill is a crisis. The Cuban missile crisis was, indeed, a crisis. The Great Depression was a crisis.

I’d like to add to that list another crisis that is on a different level, but that will without question -- and sooner rather than later — require an abrupt or decisive change: The primary care crisis. The profession of primary care physician in this country is dying. Fast.

This cannot be news to you; if you’re a primary care provider, you’ve lived with this for years. If you’re a specialist, perhaps part of the reason you chose a specialty over primary care or family practice is the woes you’ve heard about the state of primary care. You’ve heard the news reports about shortages in certain areas of the country, and we know primary care and family physicians are beset by challenges, including careers that begin under a shadow of debilitating debt; low (and getting lower) reimbursement from payers, including managed care plans, Medicare and Medicaid; staggering malpractice insurance rates; the rise of specialists in new categories, and many more. (This revealing video should forever dispel the myth of the “highly compensated” physician.)

This is a crisis, and it’s worsening. Demand for primary care physicians has never been higher, and yet the supply has never dwindled at a greater rate. Next year, the first of the Baby Boomers will turn 65. In many areas of the country, they’ll wait weeks to see a primary care physician. According to the American Academy of Family Physicians (AAFP), the number of U.S. medical school students going into primary care has dropped more than 51% in the past 13 years.

The U.S. healthcare system has about 100,000 family physicians and will need 139,531 in the next decade. AAFP is predicting shortages of 40,000 family physicians or more by the year 2020. The current environment is attracting only half the number needed to meet the demand. Healthcare reform -- by virtue of extending coverage to many of the 47 million Americans who don’t currently have insurance, and also by lowering the reimbursement rate for physicians -- will only exacerbate the problem.

A shortage of primary care physicians will have major consequences, including long waits for appointments, fewer preventive care visits, and patients turning toward more expensive emergency room visits.

Healthcare reform could have and should have taken steps toward addressing these issues. It did not. That’s a huge missed opportunity, for sure. But regardless of how we got here, that’s where we are.

Now, the onus is on physicians themselves to step up and address these issues. The profession needs a leader. It needs one now. This crisis is real, and my gut tells me that the solution has to come from within. Physicians as a group can’t repeal healthcare reform, but they must develop a stronger national voice and find a leader who can articulate the deep and serious repercussions of a pronounced primary care shortage. Otherwise, needed attention will simply accrue to the next crisis of the times.

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Victor J. Dzau, MD, gives expert advice
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