House Calls / Dr. Michael Schwartz

Dr. Michael Schwartz
Dr. Michael SchwartzContributed Photo

A primary-care physician is a medical practitioner who provides general medical care. These doctors possess a broad base of knowledge in many different areas of medicine including general well-being to acute and chronic patient care. They are essential to the medical community and an integral part of the health-care system.

Primary-care doctors include family practice physicians, internists and pediatricians. In general, primary-care doctors evaluate many conditions ranging from the simple routine cold to life-threatening heart attacks. It is estimated that there are more than 200,000 primary-care physicians in the United States, equaling approximately one-third of the total number of physicians practicing in the country. However, it is calculated that more than 50 percent of doctor visits are to primary-care practitioners; disproportionately affecting the ability for patients to see their primary-care physician in a timely fashion.

One reason that less medical students are entering the field of primary care is due to the income discrepancy between primary-care physicians and specialists. In many cases, specialists (e.g., gastroenterologist, cardiologist, pulmonologist) make at least double if not three times the income of a generalist. This compensation disparity, coupled with the significant educational debt many young physicians have, doctors entering the profession are tempted (or even forced) to pursue a career in a specialty in order to pay back student loans. Additionally, this shortage is amplified by the fact that many primary-care doctors have already closed their practice panels and are not accepting new patients, thereby reducing the number of available appointments.

Next year, patients may find it more difficult to get a timely appointment with their primary-care physician. In 2014, the Affordable Care Act, aka Obamacare, will go into effect, and millions of currently uninsured Americans will gain access the health-care system. This will place an enormous strain on the health-care system as the primary-care shortage will delay patient visits and could result in more emergency room visits by people needing to see a doctor. As more patients acquire health insurance over the next few years, primary-care doctors will be forced to see more patients to keep up with demand. Consequently, physicians who are still accepting new patients will have less time to spend with each patient which will likely affect the quality of care.

Some medical schools are developing a unique philosophy in order to deal with the need to increase the number of new primary-care physicians.

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When asked about this concerning issue, Dr. Bruce M. Koeppen, dean of the Frank H. Netter MD School of Medicine stated "We are trying to address the primary care shortage from an inter-professional perspective in cooperation with the Quinnipiac schools of nursing and health sciences."

The new medical school at the Quinnipiac University campus, beginning its inaugural year, will take aim at one of the most pressing needs in the nation today -- producing more primary-care physicians.

Koeppen believes the unique and innovative approach of having medical students work closely with other ancillary health-care professionals, e.g., nurses and physician assistants, will help produce highly qualified physicians.

"We believe primary care is best provided by an inter-professional team of care givers while allowing the physician to focus on those patients requiring a higher degree of expertise," he said. "This makes the physician's job more rewarding and attractive and expands access to care."

Koeppen also suggests that increasing reimbursement for primary-care doctors will encourage more doctors to enter these specialties.

"The Affordable Health Care Act will not only increase reimbursement for primary-care doctors, but also expand resident training positions in primary care. A good primary care network will also address patient issues before they become severe. Without that care, patients may not be able to get non-emergent care in a timely manner."

One suggestion to deal with the primary-care shortage is to utilize nurse practitioners and physician assistants more. These well-trained ancillary medical professionals are able to deliver primary care including acute and chronic medical conditions. However, nurse practitioners and physician assistants lack much of the expertise and skills possessed by primary-care doctors. The educational requirements are much more stringent for physicians when compared with ancillary medical professionals, and therefore it is recommended that physicians oversee the care administered by these professionals. Nevertheless, the "team approach" may be a solution to providing patients with primary care in a timely fashion.

Primary-care medicine is the cornerstone of health care. As more people enter the health-care system, patients may have a harder time getting an appointment to see their doctors. Fortunately, some medical schools are taking the lead in promoting these fields of medicine, and are training more individuals to become primary-care doctors. This will ultimately result in providing better access to quality medical care. Ancillary medical professionals can help fill the gap with routine medical illnesses while the physicians can address the patients with more complex or chronic diseases. However, until more doctors are trained as primary care physicians, patients will have to be patient.

Dr. Michael Schwartz is board certified in internal medicine with a private practice in Darien. For comments or questions, visit his website at