PCP visits declined 18 percent over 4 years

[235009]

Unfortunately not looking good for primary care bound physicians in the current environment where instant gratification culture has led to the proliferation of urgent care and minute clinics that cost the same up front to the patient.

The Disappearing Doctor: How Mega-Mergers Are Changing the Business of Medical Care (Published 2018)

Big corporations — giant retailers and health insurance companies — are teaming up to become your doctor.

www.nytimes.com

Excerpt:
"CVS [...], and most recently Walmart [...], are eyeing deals with Aetna and Humana, respectively, to use their stores to deliver medical care.

People are flocking to retail clinics and urgent care centers in strip malls or shopping centers, where simple health needs can usually be tended to by health professionals like nurse practitioners or physician assistants much more cheaply than in a doctor’s office. Some 12,000 are already scattered across the country, according to Merchant Medicine, a consulting firm."

---

Members don't see this ad.

 

[mistafab]

I forsee that this will be more and more of the case. In the 21st century, a patient-doctor relationship is a luxury. The health care landscape is setting up more and more to be a “cog in the system” design where customer service and interchangable parts are more efficient than personalized or expert care. What I see in the future is that you won’t have a doctor for primary care (unless you join a concierge practice), you will be a CVS patient or Aetna patient. You will show up to their door when you need a provider, and a random provider will open your chart and take care of your issue.

USA has made it clear that they do not prioritize prevention and betterment of health. USA health care promotes sick visits only, and only the wealthier will be able to afford a true doctor-patient relationship anymore. I see the future being that the majority of patients will have sick visits or vaccines only while conceirge practice will be available for the higher income owners who want to improve their health or increase longevity. It’s not necessarily anyones fault, but that is what the pressure to save healthcare dollars leads to. The people that don’t need to save will get better care, and everyone else will just have to take what they can get.

 

[Goro]

Unfortunately not looking good for primary care bound physicians in the current environment where instant gratification culture has led to the proliferation of urgent care and minute clinics that cost the same up front to the patient.

The Disappearing Doctor: How Mega-Mergers Are Changing the Business of Medical Care (Published 2018)

Big corporations — giant retailers and health insurance companies — are teaming up to become your doctor.

www.nytimes.com

Excerpt:
"CVS [...], and most recently Walmart [...], are eyeing deals with Aetna and Humana, respectively, to use their stores to deliver medical care.

People are flocking to retail clinics and urgent care centers in strip malls or shopping centers, where simple health needs can usually be tended to by health professionals like nurse practitioners or physician assistants much more cheaply than in a doctor’s office. Some 12,000 are already scattered across the country, according to Merchant Medicine, a consulting firm."

I suspect that the silver lining in this is that when those NPs and PAs screw up, it's more work for doctors!

 

[Raney Schauer]

I suspect that the silver lining in this is that when those NPs and PAs screw up, it's more work for doctors!

Read: depositions.

 

[PathoTurnUp1865]

In the last 10 years urgent care clinics have popped up all over the place. Absolutely ridiculous. They look like a McDonalds franchise, big "URGENT CARE" on the front, often in a strip mall. Not even physician-owned, just some corporate money-grab. Pathetic if you end up working for one.

I can’t imagine much worse than being a doc in a box.

 

[Rekt]

I can’t imagine much worse than being a doc in a box.

Having some high expectations here. These are rarely staffed by anything but a mid-level.

 

[PathoTurnUp1865]

Having some high expectations here. These are rarely staffed by anything but a mid-level.

Very true. Anytime I’ve gone I’ve been asked “so what do you want me to prescribe you” by an NP/PA and I almost always fall out of my seat lol

 

[ArdorAyurveda]

Assembly line medicine

 

[DO2015CA]

Unfortunately not looking good for primary care bound physicians in the current environment where instant gratification culture has led to the proliferation of urgent care and minute clinics that cost the same up front to the patient.

The Disappearing Doctor: How Mega-Mergers Are Changing the Business of Medical Care (Published 2018)

Big corporations — giant retailers and health insurance companies — are teaming up to become your doctor.

www.nytimes.com

Excerpt:
"CVS [...], and most recently Walmart [...], are eyeing deals with Aetna and Humana, respectively, to use their stores to deliver medical care.

People are flocking to retail clinics and urgent care centers in strip malls or shopping centers, where simple health needs can usually be tended to by health professionals like nurse practitioners or physician assistants much more cheaply than in a doctor’s office. Some 12,000 are already scattered across the country, according to Merchant Medicine, a consulting firm."

What do you suggest for those of us that despise the hospital setting

 

[puahate]

Then we have people telling med students to go into PC. Med students already see the writing on the wall and won't gamble.

Med students understand this. Look how fast they avoided rad onc.

 

[VA Hopeful Dr]

What do you suggest for those of us that despise the hospital setting

Primary care is fine. Every single town in my state over 20,000 people is hiring PCPs.

Besides, urgent cares don't take care of the ever increasing burden of chronic disease patients.

 

[DO2015CA]

Primary care is fine. Every single town in my state over 20,000 people is hiring PCPs.

Besides, urgent cares don't take care of the ever increasing burden of chronic disease patients.

I tend to agree for chronic disease management. I was just looking for his thoughts as a CC doc and what he supposes we do about it even if it is true

 

[235009]

What do you suggest for those of us that despise the hospital setting

1. Outpatient subspecialty of IM: Endocrine, rheumatology, pulmonary (without critical care), cardiology.
2. Psychiatry

 

[ArdorAyurveda]

Then we have people telling med students to go into PC. Med students already see the writing on the wall and won't gamble.

Med students understand this. Look how fast they avoided rad onc.

PC isn't all that bad, sports medicine could be interesting. Or even preventive medicine could be cool. It's all about being flexible.

I think the important thing is to become an owner rather than an employee. At least that how I'm looking at things. You'll have more freedom working for yourself rather than working for the boss

 

[jdh71]

Unfortunately not looking good for primary care bound physicians in the current environment where instant gratification culture has led to the proliferation of urgent care and minute clinics that cost the same up front to the patient.

The Disappearing Doctor: How Mega-Mergers Are Changing the Business of Medical Care (Published 2018)

Big corporations — giant retailers and health insurance companies — are teaming up to become your doctor.

www.nytimes.com

Excerpt:
"CVS [...], and most recently Walmart [...], are eyeing deals with Aetna and Humana, respectively, to use their stores to deliver medical care.

People are flocking to retail clinics and urgent care centers in strip malls or shopping centers, where simple health needs can usually be tended to by health professionals like nurse practitioners or physician assistants much more cheaply than in a doctor’s office. Some 12,000 are already scattered across the country, according to Merchant Medicine, a consulting firm."

A lot of this is all appropriate though. These are the cases of mostly bull**** that a PCP would have to try and squeeze into a day. Managing and dealing with preventive medicine in the healthy but aging population and chronic disease in the rest. The 23 y/o with a "cough" is best dealt with at the urgent care at least initially I know I don't want to see it that bad and I doubt neither of my PCP colleagues do either. If it's still there after a few weeks, we can talk.

 

[afib123]

Just from personal experience, the advent of NPs and other mid-levels in primary care make people's experience in primary care horrible with PCP seeming like a referral person.
Primary care people-You guys should seriously consider limiting mid-levels into your field. Makes your whole field look bad when lots of common people have no clue the difference between an NP and MD.
Raise the standards in family medicine residencies across the country. Working in speciality clinics, I have seen some PCPs that are absolutely horrible and pretty much refer everyone without any sort of work up. I do think lot of them were mid-levels (looking at the notes of PCP referrals to speciality clinics). Family physicians need to be the master diagnosticians. They might not be able to treat every disease, but should be able to pick up diseases, and do a basic work them up before referring to the specialists. I have seen lot of good PCPs but also equal number of bad ones, possibly making people not want to go a PCP.

 

[Neopolymath]

A lot of this is all appropriate though. These are the cases of mostly bull**** that a PCP would have to try and squeeze into a day. Managing and dealing with preventive medicine in the healthy but aging population and chronic disease in the rest. The 23 y/o with a "cough" is best dealt with at the urgent care at least initially I know I don't want to see it that bad and I doubt neither of my PCP colleagues do either. If it's still there after a few weeks, we can talk.

This is the reasonable response I have come to love from your posts. I don't want to argue about the merits of being a PCP in this thread, but as a young person I think it's absurd that these people can't just get their work excuse or whatever and be on their way. Who became a doc to deal with that? It's seems like med students want it both ways. They don't want to deal with this stuff, but they don't want midlevels to do so, either, which doesn't help access to care.

 

[Goro]

This is the reasonable response I have come to love from your posts. I don't want to argue about the merits of being a PCP in this thread, but as a young person I think it's absurd that these people can't just get their work excuse or whatever and be on their way. Who became a doc to deal with that? It's seems like med students want it both ways. They don't want to deal with this stuff, but they don't want midlevels to do so, either which doesn't help access to care.

Yup, let 'em take care of shots and sniffles. Leave the heavy lifting to doctors.

 

[SDunkey]

Checked who the OP was. Not surprised...

 

[VA Hopeful Dr]

This is the reasonable response I have come to love from your posts. I don't want to argue about the merits of being a PCP in this thread, but as a young person I think it's absurd that these people can't just get their work excuse or whatever and be on their way. Who became a doc to deal with that? It's seems like med students want it both ways. They don't want to deal with this stuff, but they don't want midlevels to do so, either which doesn't help access to care.

Because if every patient is a complicated mess your day sucks.

The poison ivys, flus, sprained ankle break up the day nicely.

 

[username456789]

Because if every patient is a complicated mess your day sucks.

The poison ivys, flus, sprained ankle break up the day nicely.

This. A thousand times this.

And much of the time those complicated long patient visits may not reimburse any more than the quick acute slam dunk cases.

 

[Neopolymath]

Because if every patient is a complicated mess your day sucks.

The poison ivys, flus, sprained ankle break up the day nicely.

There are enough of these cases to go around, no? I understand the sentiment as it is a fear in my intended field as well, but I just can't see these colds and work notes disappearing outright from your daily activities if the demand for PCPs is as high as you say it is (I believe you.)

 

[jdh71]

Because if every patient is a complicated mess your day sucks.

The poison ivys, flus, sprained ankle break up the day nicely.

I don’t want things breaking up my tightly scheduled day. I will see scary nodules and masses same day or next few at lunch. And I can get in two at lunch time and finish the documentation. A couple of new problems that need an invasive biopsy by me? You can’t get much better clinic RVU in an hour than that. Everything else can go to ED, Urgent Care, or PCP. Glad you’re still happy to see it. It doesn’t even bother me if an APP takes a first whack at it

 

[VA Hopeful Dr]

I don’t want things breaking up my tightly scheduled day. I will see scary nodules and masses same day or next few at lunch. And I can get in two at lunch time and finish the documentation. A couple of new problems that need an invasive biopsy by me? You can’t get much better clinic RVU in an hour than that. Everything else can go to ED, Urgent Care, or PCP. Glad you’re still happy to see it. It doesn’t even bother me if an APP takes a first whack at it

It's almost like you're some kinda specialist...

 

[jdh71]

It's almost like you're some kinda specialist...

I am. But you might be surprised by the number of respiratory complaints that patients want or need seen TODAY.

 

[VA Hopeful Dr]

I am. But you might be surprised by the number of respiratory complaints that patients want or need seen TODAY.

I was more going after you being happy seeing a full schedule of complicated patients.

 

[jdh71]

I was more going after you being happy seeing a full schedule of complicated patients.

Oh. Definitely. I get to focus in a lot more than you guys. Even in the setting of lots of complicated chronic conditions.

 

[siliso]

Theres still plenty of demand for PCPs, job market excellent, recruiters always on the hunt. An urgent visit center doesn’t replace primary care except for people who don’t really go to primary care anyway - the young minimally morbid with minor/temporary complaints. Minute Clinic is not going to manage your diabetes, hypertension, CHF, CAD, depression, chronic pain, not going to order and follow up studies and consultations, not going to make sure you’re up to date on preventive care and screenings...and the people are only getting older and more comorbid. If I don’t have to see 25 yo Susie for her viral URI, I’ve got more access for 75 yo Elmer and his 15 chronic conditions and 2 page med list and by the way he’s depressed and having increasing dyspnea on exertion. It’s okay.

OTOH I won’t appreciate dealing with Susie’s c diff and vaginitis after the inappropriate abx that pour out of UVCs. Or Elmer’s delayed dx of lung cancer or heart failure after he got treated at the Minute Clinic with augmentin and tessalon for 3 month cough and dyspnea. Downsides are real.

 

[siliso]

I sure do love working in a quasi single payer system where my RVUs don’t matter to anything except 10% of my potential bonus, though. And we trade off doing walk in time, a half day or two a week to enjoy the simplicity of rashes and vag itch and URI after URI while fobbing the rest off to their upcoming PCP visit.

 

[Booze Aldrin]

Theres still plenty of demand for PCPs, job market excellent, recruiters always on the hunt. An urgent visit center doesn’t replace primary care except for people who don’t really go to primary care anyway - the young minimally morbid with minor/temporary complaints. Minute Clinic is not going to manage your diabetes, hypertension, CHF, CAD, depression, chronic pain, not going to order and follow up studies and consultations, not going to make sure you’re up to date on preventive care and screenings...and the people are only getting older and more comorbid. If I don’t have to see 25 yo Susie for her viral URI, I’ve got more access for 75 yo Elmer and his 15 chronic conditions and 2 page med list and by the way he’s depressed and having increasing dyspnea on exertion. It’s okay.

OTOH I won’t appreciate dealing with Susie’s c diff and vaginitis after the inappropriate abx that pour out of UVCs. Or Elmer’s delayed dx of lung cancer or heart failure after he got treated at the Minute Clinic with augmentin and tessalon for 3 month cough and dyspnea. Downsides are real.

Sounds like you're fine with being what's colloquially known as a "chump." The corporations and their army of nurses will happily see and bill for 2 Susies in the time it takes you to see 1 Elmer. With the new flat rate for office visits soon to arrive, the easy cough will reimburse just as much as your dying cancer patient with 20 comorbidities. You're a lucky man that you're not upset at being suckered into taking care of the trainwrecks for minimal pay while the online trained folks with no opportunity cost make out like bandits on the URIs. That's the future, so it's good you're cool with it.

 

[siliso]

As I noted, my work and payment structure are favorable to this model for me. I’m a happily employed VA doc, like taking care of my panel and already get basically a flat rate for doing so. And I’m home about to have a nap on this lovely Fri afternoon. The water is fine, for me, a chump

 

[Booze Aldrin]

As I noted, my work and payment structure are favorable to this model for me. I’m a happily employed VA doc, like taking care of my panel and already get basically a flat rate for doing so. And I’m home about to have a nap on this lovely Fri afternoon. The water is fine, for me, a chump

Present != Future

I hope you don't think whatever gig you've got going on in the VA will magically remain unaffected by the forces wrecking the private sector? They'll pay you and treat you no better than they have to, and if the private sector docs lose out and start beating at the doors of those VA jobs as an escape guess what's going to happen when your contract comes up for renegotiation? lol

 

[siliso]

True enough, but I don’t suppose your crystal ball is all that much clearer than mine. I keep my skills flexible and flexed in various modes of practice so to adapt to what may be. PCPs may be less in demand in the future, in which case I have what else to do, although I’d miss it and think quality of care would suffer. Or, if our health care payment system miraculously becomes more sane (and more vertically integrated with the same parties responsible for all costs inpt and outpt as in my own present system), we may be more in demand. Que sera sera.

 

[aafisahar]

I forsee that this will be more and more of the case. In the 21st century, a patient-doctor relationship is a luxury. The health care landscape is setting up more and more to be a “cog in the system” design where customer service and interchangable parts are more efficient than personalized or expert care. What I see in the future is that you won’t have a doctor for primary care (unless you join a concierge practice), you will be a CVS patient or Aetna patient. You will show up to their door when you need a provider, and a random provider will open your chart and take care of your issue.

USA has made it clear that they do not prioritize prevention and betterment of health. USA health care promotes sick visits only, and only the wealthier will be able to afford a true doctor-patient relationship anymore. I see the future being that the majority of patients will have sick visits or vaccines only while conceirge practice will be available for the higher income owners who want to improve their health or increase longevity. It’s not necessarily anyones fault, but that is what the pressure to save healthcare dollars leads to. The people that don’t need to save will get better care, and everyone else will just have to take what they can get.

The whole private insurance thing is killing primary care. I have a chronic condition that requires at least 6 month monitoring. Prior to medicine, in my old job, I had to change PCPs three times in three years because of our insurance changes and who was and wasn't in-network.

Unless you have Medicaid or Medicare, no one should count on having the same PCP for more than a couple years if you are lucky.

 

[siliso]

@Booze Aldrin PS we have no contracts or noncompetes lol. We have security and tenure and no mechanism by which salaries and benefits are reduced - and a union! And the doors are not beat down for as you may have heard there’s a primary care Shortage not Surplus. But even if that changed my freedom is still free to go do whatever wherever, Deo gratias. And my position somewhat sheltered by working with students and residents, which I v much enjoy. And take tradeoff in money (still more than enough) for life and time and satisfaction. Get in the job market first and then tell me your insights mkay?

 

[sunshinefl]

I find this very depressing as someone interested in adult primary care and long term doctor-patient relationships. And that’s why the 2nd thread I started in my almost 5 years here was about concern of PCP demand. And some took it to be beating a dead horse, annoying, or trolling. But I’m genuinely concerned because this is what I want to do (most likely).

 

[SLC]

I find this very depressing as someone interested in adult primary care and long term doctor-patient relationships. And that’s why the 2nd thread I started in my almost 5 years here was about concern of PCP demand. And some took it to be beating a dead horse, annoying, or trolling. But I’m genuinely concerned because this is what I want to do (most likely).

The OP’s article was trotted out with little to no thought apparently given to what primary care physicians actually do (though we do have to leave room for the possibility it could be pure ignorance). It seems as though this person thinks primary care doctors see nothing more than coughs and colds for a living.

Minute Clinic/doc in a box type places are not putting primary care doctors out of business, and they aren’t threatening to do so either.

As has been said many times by the people with real world experience in the field, primary care docs make a living managing the ongoing care of people with chronic disease; among many other things. Sick visits in otherwise healthy young folks like we’re highlighted in the article are a tiny fraction of what a primary care doc sees, and believe me, there are still plenty of those visits to go around despite the midlevel sweatshop phenomenon.

The types of patients you (as a primary care doctor) establish actual therapeutic relationships with are not the ones that only come in when they get the sniffles. They are the ones with DM, CHF, COPD, CKD, Depression, substance problems, family planning needs, pediatric development disorders, malignancy, orthopedic issues, etc. More often than not it’s some combination of the things listed above.

Believe me, if you’ve got an actual interest and aptitude for the work, you’re needed; and you will always have a waiting room full of people asking for your services.

No amount of “minute clinics” will change that.

 

[SLC]

What do you suggest for those of us that despise the hospital setting

Primary care.

This article shouldn’t change that.

 

[Splenda88]

I find this very depressing as someone interested in adult primary care and long term doctor-patient relationships. And that’s why the 2nd thread I started in my almost 5 years here was about concern of PCP demand. And some took it to be beating a dead horse, annoying, or trolling. But I’m genuinely concerned because this is what I want to do (most likely).

You should be concern because ANA thinks the best way to take over the primary care market is to flood the market with NP, hence online NP schools which require 500 hrs preceptorship. The other day one nurse where I work was taking an online test while at work and asked me for help; I did help her on a few questions. Scary!

 

[AMEHigh]

Ehh, I’m not too worried. The beauty of family med are that there are soooo many job opportunities, even within clinical medicine. Academics, working for the government, health departments, FQHCs, the VA, hospitalist, colleges/universities health centers, private employers, private practice, urgent care, direct primary care, nursing homes, hospice, etc etc. That doesn’t even account for all the non-clinical options.

Our jobs aren’t in danger anytime in our lifetime. I think our skills are translateable to a lot of areas unlike someone who is super specialized like a pediatric cardiothoracic surgeon for example. Being primary care trained you can literally get a job anywhere in the country and even overseas.

So for all those in training with an interest in primary care please don’t let the prospect of not having a job scare you off. That is not true in all practical senses.

 

[AMEHigh]

I find this very depressing as someone interested in adult primary care and long term doctor-patient relationships. And that’s why the 2nd thread I started in my almost 5 years here was about concern of PCP demand. And some took it to be beating a dead horse, annoying, or trolling. But I’m genuinely concerned because this is what I want to do (most likely).

See my response above. You will have no problem getting a job being primary care trained in either family or internal medicine.

 

[Little Green Mensch]

The Doc-In-The-Box clinics are only good for things that don't really require medical attention in the first place. Anything even a little bit out of the ordinary, they will turf to the ED.

I think the decline in PCP visits is multi-factorial, but minute clinics are almost certainly a part of it. PCPs could combat this by offering weekend and evening hours, but that can be hard to do if you're in a small practice.

 

[nimbus]

Corporate medicine is taking over many other specialties too. Off the top of my head I can think of EM, radiology, anesthesia, NICU, derm, plastics, and ophtho. It’s not like you can avoid the scourge.

 

[Osminog]

Walmart medical clinics would be nice. "Excuse me, where can I find the pickled eggs and frozen meatloaf? Also, where do I go for my rectal exam?"

Sounds like medicine is gradually moving in the direction of pharmacy, i.e., the wrong direction.

 

[MedicineZ0Z]

"What's wrong with NPs seeing simple cases so doctors can focus more on complex patients"

 

[Splenda88]

"What's wrong with NPs seeing simple cases so doctors can focus more on complex patients"

Any physician who thinks that should the case is a ***... For instance, why would an anesthesiologist toss the healthy 25-year old who is here for a simple elective surgery to a CRNA so he/she can take on the 68-y old with HFrEF (25%), stage 3 COPD, DM (A1C 11.6), OSA, substance use disorder that has a BMI >50 who will be undergoing a major surgery? So later AANA can come up with studies saying anesthesia complications are the same for both MD/DO vs CRNA... We are our worse enemy.

It's strange that physicians start adopting ANA languages. You hear they say stupid things like "We can give them the easiest cases so we can take on more challenging ones." Now the word 'provider' is mainstream amongst docs even if they are talking with their peers... This is crazy!

 

[nimbus]

Any physician who thinks that should the case is a ***... For instance, why would an anesthesiologist toss the healthy 25-year old who is here for a simple elective surgery to a CRNA so he/she can take on the 68-y old with HFrEF (25%), stage 3 COPD, DM (A1C 11.6), OSA, substance use disorder that has a BMI >50 who will be undergoing a major surgery? So later AANA can come up with studies saying anesthesia complications are the same for both MD/DO vs CRNA... We are our worse enemy.

This rarely happens in real life. Assignments are made the day before when we don’t know anything about the patients. And in reality everybody wants the healthy 25yo because their insurance pays 3-5x Medicare which is what the sick 68yo has.

 

[siliso]

NPs and PAs exist and work, and have for decades, and the job market for PCPs is still more than excellent. It’s not a topic of giant butthurt or concern to me, although reviewing post histories suggests it’s a major hobbyhorse for some. I don’t have a strong stance either way, I’ve seen NPs in my own PCP office who’ve done a good job for me/my kid and staff appropriately with their supervising physicians - and I’ve worked around PA students about to graduate and thought I’m really glad you’re going to be working under supervision and wouldn’t support removing requirements for supervision of NPs and PAs. I think they work best as perma-residents in places that don’t have (or have enough) residents.

If the real concern is territory/market/salary protection though, isn’t it worse for me to train med students and residents? I mean they really will be exactly able to take my personal job. Is that chump behavior also? Should the wised up MD refuse to participate in medical education? It’s not pharmacy techs or paralegals that caused market saturation in pharm and law, it’s actual PharmDs and JDs. Though they don’t have the bottleneck of Medicare funding for required residencies protecting them from glut like we USMDs do.

TLDR neither urgent cares nor midlevels, both of which have existed for many years, are killing the market for primary care physicians - it’s still great, as every practicing PCP here has told you. The sky continues to be aloft.

 

[MedicineZ0Z]

NPs and PAs exist and work, and have for decades, and the job market for PCPs is still more than excellent. It’s not a topic of giant butthurt or concern to me, although reviewing post histories suggests it’s a major hobbyhorse for some. I don’t have a strong stance either way, I’ve seen NPs in my own PCP office who’ve done a good job for me/my kid and staff appropriately with their supervising physicians - and I’ve worked around PA students about to graduate and thought I’m really glad you’re going to be working under supervision and wouldn’t support removing requirements for supervision of NPs and PAs. I think they work best as perma-residents in places that don’t have (or have enough) residents.

If the real concern is territory/market/salary protection though, isn’t it worse for me to train med students and residents? I mean they really will be exactly able to take my personal job. Is that chump behavior also? Should the wised up MD refuse to participate in medical education? It’s not pharmacy techs or paralegals that caused market saturation in pharm and law, it’s actual PharmDs and JDs. Though they don’t have the bottleneck of Medicare funding for required residencies protecting them from glut like we USMDs do.

TLDR neither urgent cares nor midlevels, both of which have existed for many years, are killing the market for primary care physicians - it’s still great, as every practicing PCP here has told you. The sky continues to be aloft.

I think you pointed out just why this "bottleneck" exists. If you opened new residencies, good luck finding adequate educators and optimal settings. We already have enough bad ones.

 

[Mad Jack]

Unfortunately not looking good for primary care bound physicians in the current environment where instant gratification culture has led to the proliferation of urgent care and minute clinics that cost the same up front to the patient.

The Disappearing Doctor: How Mega-Mergers Are Changing the Business of Medical Care (Published 2018)

Big corporations — giant retailers and health insurance companies — are teaming up to become your doctor.

www.nytimes.com

Excerpt:
"CVS [...], and most recently Walmart [...], are eyeing deals with Aetna and Humana, respectively, to use their stores to deliver medical care.

People are flocking to retail clinics and urgent care centers in strip malls or shopping centers, where simple health needs can usually be tended to by health professionals like nurse practitioners or physician assistants much more cheaply than in a doctor’s office. Some 12,000 are already scattered across the country, according to Merchant Medicine, a consulting firm."

A lot of the urgent cares are run by the same groups that run the primary care offices around here, so they end up making money either way