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Dr. Bodenheimer’s article hits the nail on the head in identifying the barriers family physicians face. As a physician in Nevada, which ranks near the bottom in the nation in primary care physicians per capita, I can personally attest to the stress of a large patient panel as we struggle to balance the needs of our existing patients with people in our community without a primary care home and our own mental health.
In my experience, and in talking to other practices, the stresses on practices seem worse now than at the start of the pandemic. One factor contributing to this additional stress is the effect of the “great resignation” on medical practices.
According to some articles, the great resignation has hit the medical sector harder than other business sectors. As a result, hospitals and practices must increase wages to hire and retain staff. As family medicine is one of the lower-paying areas of medicine, I would suggest that our specialty has been hit even harder. Many practices I have talked with are losing long-term staff as they take jobs with specialty groups or hospitals that can afford to pay them more. For example, I am running a practice without an office manager for the first time. I’ve found it impossible to hire someone with the practice experience needed to help our clinic manage the complexities of primary care (MIPS/MACRA/ACOs) at a rate I can afford. Instead, I’m using that money to pay my staff more in the hopes to retain them.
I would agree that part of the solution to practices with large patient panels like mine is to hire more staff and implement a more team-based approach. Sadly, it’s getting close to impossible for me, and likely other small practices, to be able to afford to do so.