John R. Fischer

A few days ago, while working out, I pinched a nerve or pulled a muscle in the lower right part of my neck. Since then, the pain has been excrutiating at times to the point where I have only been able to sleep for a four hours. Last night, I thought about calling the doctor but chose not to for two reasons.

One, I’ve been in this situation before and know the procedure: the doctor comes in, looks me up and down, tells me to take Tylenol and rest and sends me on my way. And two, the cost.

You see, I am among the more than 100 million Americans who do not have a primary care doctor and not for a lack of trying. During the summer, I saw a primary care physician in my neighborhood. She ran some blood tests and told me I needed to see a gastroenterologist because my cholesterol was high. I mentioned this to a friend who’s a resident at Mount Sinai, studying family medicine. He told me my results are more or less common around a lot of people our age and that he did not think a gastroenterologist was necessary.

This difference in opinion is confusing, and the lack of agreement and standardization among different professionals makes me question the quality of the care I’m receiving. As a result, I often end up having to go to the ER or urgent care when I have a minor, leading me to incur a massive bill. For instance, a trip to urgent care back in July for a muscle I pulled in my leg cost me over $200. I don’t think the doctor even touched me leg, let alone asked me to remove my jeans so he could get a better look. All he said was to rest and take some Advil.

It is not the treatment regimen that bothers me. I know there’s probably nothing more he can do, and he’s not going to prescribe me opioids. I know I don’t need those. What bothers me is the cost for a visit that didn’t even last ten minutes.

At the same time, not being able to trust a physician to be my primary care doctor is also frustrating. No matter how hard I look, there’s no one single tool or rating website that gives me enough information to make a decision, especially in my neighborhood. Many of the physician reviews I have read puts ranks most physicians as three stars as most, with some having no stars at all or even a picture. And many of the calls I’ve made to physicians offices have either ended with a message saying the number is no longer in service or an assistant who says that the online profile is wrong and that the physician is not a general practitioner but a specialist who I know will cost me more money through my insurance. Some even are not fluent in English. I try not to hold this against them, but it does make me concerned that they may misinterpret what I tell them, and therefore, misdiagnose me and give me the wrong treatment.

Believe me, I know I’m not in the worst situation. At least I have physicians around me. Some people, especially in rural areas, are 20 miles from the nearest physician and have no car or transportation to get them. This is how a lot of people end up without a primary care physician. Instead, many go to closerby ERs and urgent cares for even something like a scrape because they are unable to make the trip to a general practitioner. Clinic closures and consolidation of independent practices have only made this even more challenging along with the shortage of primary care providers available to begin with.

Even before the pandemic burned out many to the point where they up and left the medical profession all together, primary care physicians has been on the decline for almost a century. In his book, Patients in Peril: The Demise of Primary Care in America, published in 2022, internal medicine physician Dr. Gregg Coodley says that the number of American physicians practicing primary care dropped from 87% in the 1930s to 50% in the early 1960s as specialists began to outpace them and eventually to 35% in the 1970s. At the time, a referral was not needed to see specialists. Additionally, the appeal of higher incomes has led more med students and residents to commit to specialty than primary care, along with the ability to work fewer hours.

Today, about 25% of U.S. doctors work in adult primary care, according to the Association of American Medical Colleges. Because of this shortage, along with the distance for many to travel and expensive nature of alternative urgent care and ER options, some patients choose to delay or forgo care all together, allowing their ailments to advance and become chronic and in some cases, terminal.

For Americans to have access to appropriate care, there needs to be a greater amount of transparency and standardization among physicians and with the public. People need to understand the right questions to ask in order to determine if a primary care physician is the right doctor for them. While opinions can differ, there should be some degree of consensus on whether or not an issue is urgent, based on universal and standardized guidelines.

There also needs to be greater transparency about the cost of ER and urgent care versus providers. Often, it is a lack of awareness and the desire for a closer and convenient option that leads patients to the ER and urgent care, despite their financial struggles.

At the same time, greater efforts are needed to ensure patients have direct access within their communities to quality care. Rather than having to travel miles or hours on end, there should be at least one local primary care provider available. Some states are trying to make this happen in rural areas, providing incentives to med students finishing up residency to take up jobs in the countryside. The U.S. government is also trying to crack down more on corporate takeovers and consolidations to ensure patients have multiple options to choose from for their care needs and competition among different healthcare practices remains fair.

But more needs to be done to facilitate local access and to recruit more future primary care doctors to reduce current shortage. There needs to be greater investment in the salaries and benefits of primary care to put it on par with specialty care and attract more physicians to this branch of medicine.

If not, many like myself will continue to have a hard time finding a doctor whose opinion and quality of care can be trusted, leading us to continue to turn to more expensive ER and urgent care practices for our needs.

I am still searching for a quality doctor and am due to see one in February on Long Island. From where I am in Brooklyn, the trip should be about two hours, give or take. Luckily, I have family I can stay with, but not everyone is as fortunate, which is why we must do more to not just increase access to care but make it more equitable geographically and in quality.