Where Have the Primary Care Doctors Gone? Understand the Changing Landscape of Medicine

Dr. Jeffrey Gaber, practices internal medicine and leads Dr. Gaber & Associates, a medical practice located in Baltimore and Pikesville known for providing patient-centered care.

Forty-three years ago, when Dr. Gaber began his medical journey, the landscape of medicine and finding a primary care doctor was significantly different. Dr. Gaber commented that during his early days of practice, many physicians went into internal medicine. Some started their own practice. Dr. Gaber explained that these days, few choose to go into internal medicine or start their own practice to deliver care to patients. 

“That’s almost completely unheard of,” he added.

The Evolution of Medical Care You May Have Missed

This evolution is tied to the difficulty a person can experience today in finding a new primary care doctor. The prevalence of different styles of medical practices now includes a membership model known as concierge medicine. Patient loads are smaller, and easier access is provided to get in touch with health care providers. More time is spent with patients who spend $2,000 a year or more. 

 “One is that a number of them [doctors] have gone into the concierge style of medicine in which they limit their practice to anywhere from 400 to 600 patients total, whereas a normal practice would have 2,000 – 3,000 patients, let’s say,” Dr. Gaber explained. “From what I’m told, lots of docs who do this style of medicine like it.”

Dr. Gaber pointed out another noteworthy factor.

“Next, there are fewer doctors graduating from their residency programs in internal medicine who choose to go into primary care. Many of them pursue a hospitalist-style of medicine. A hospitalist is a doctor who is hired by a hospital and works solely within the hospital. In other words, that’s their nine-to-five job.”

He stressed that these doctors are “not doing real primary care at all.” Upsides for these doctors who have completed their residency programs include reduced hours and fewer responsibilities, such as managing an office or hiring and firing staff.

“And three, they get paid pretty well right away. And so, all these things are very appealing to them. A lot of them have loans still to deal with from med school,” Dr. Gaber added.

Another reason doctor shortages are increasing is that after a few years of practicing internal medicine, some doctors choose to do something else.

 “They can’t stand how medicine is being practiced nowadays to some degree,” Dr. Gaber suggested.

He mentioned that the impersonal nature of medicine, including electronic medical records, being stuck on the computer all the time, and the vast amount of time spent on administrative tasks instead of patient care, does not appeal to them.

Dr. Gaber stated that patients can find it difficult to find a primary care provider because providers who are accepting new patients are often so busy that obtaining an appointment can take six months.

“I hear that all of the time,” Dr. Gaber explained. “Or they are not taking any more patients.”

Lastly, when patients want a doctor who belongs to a particular religion, is located in a specific area, is of a particular gender, or speaks a specific language, their choices can be further limited. These problems with primary care do not only exist in Maryland but all over the country, according to Dr. Gaber.

The Patient Impact

There was a time when patients did not have to deal with a big corporate style of medicine and patients were more than computer numbers.

“We used to have an ad. It was a little bit tongue-in-cheek. I actually made it up. It said, ‘Think of us as a concierge medicine, but without the fee.’ In other words, you don’t have to pay me $2,000 to come in the same day if you’re sick; or for us to return your phone call in a proper fashion; or you don’t have to pay me for that; or for me to call your specialist up to discuss your case. That’s what we’re supposed to do, right? You don’t have to pay me extra to do what I’m supposed to do,” said Dr. Gaber.

Visit www.drgaber.com for more information about Dr. Gaber & Associates.