Commentary: Americans Can’t Afford to Lose Access to Their Doctors

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Patients face increasing barriers to healthcare access as physician shortages rise and Medicare payment systems fail to support independent practices.

Whenever Washington makes a big decision about the future of our nation’s health care system, patients should always be at the forefront. This means finding ways to make it easier for Americans—whether in rural South Dakota or downtown Los Angeles—to access care close to home.

Terry Wilcox | Image: Patients Rising

But too often, policy decisions fall short of this goal, and we’re seeing the consequences. There aren’t enough doctors to meet Americans’ growing demand for care. The US is short roughly 37,000 physicians right now, and is on track to need 86,000 more physicians by 2036, according to the Association of American Medical Colleges.¹Moreover, too many communities lack primary and specialty services, and patients are being forced to wait longer to see their doctor.²

One reason behind these troubling trends is that Medicare’s outdated payment system is quietly—and steadily—threatening to drive independent physicians out of practice. According to data from the American Medical Association, average physician payment through the Medicare Physician Fee Schedule (MPFS) has fallen by a staggering 33% since 2001 when adjusted for inflation.³

These payment rates have become so low that many doctors are struggling to stay in business. Instead, they’re forced to sell their practice to large health systems or retire early. And when care shifts from a neighborhood clinic to a major hospital, costs usually go up,⁴ personal connections are lost, and care becomes more impersonal.

This kind of consolidation might make sense on a spreadsheet, but it doesn’t make sense for patients. Nothing about the current system is sustainable, neither for physicians nor the communities who put their faith in their healing hands.

At Patients Rising,⁵ we work to support policies that protect and empower patients across the country—folks who rely on consistent, local care to manage chronic health conditions, recover from serious illness, or just stay healthy. More and more patients are struggling to access care as their doctors retire, leave to work in a big health system, or decide to stop accepting Medicare beneficiaries as patients.

Less access to independent physicians in their communities forces too many patients to drive an hour or more to the next provider, wait weeks to be seen, or navigate confusing layers of hospital billing departments. It’s frustrating. It’s disheartening. It’s becoming far too common. And, worst of all, it would be completely avoidable if our leaders in Washington made some simple tweaks to strengthen the Medicare system.

If we don’t fix how Medicare pays doctors, that number is only going to grow. Ultimately, patients will suffer the most.

One solution is to tie payments to the actual cost of running a practice—including inflationary updates like other Medicare providers get—so doctors aren’t being paid based on outdated formulas that don’t reflect today’s economy. Recently, Congress looked poise to do so as part of its reconciliation package but unfortunately failed to move forward with the proposal.⁶ Lawmakers must revisit this idea this session. Another important solution is to stop paying hospitals more for the exact same services an independent doctor provides. That’s just unfair, and it drives consolidation for all the wrong reasons.⁷

This issue may sound like something only policymakers or health economists think about, but it’s hitting patients right where it hurts. When your doctor leaves town, when your wait to be seen stretches to months, when the price of a simple appointment doubles because it now takes place in a hospital-owned facility—that’s when this becomes real. That’s when people start to ask, why are we letting this happen?

Patients deserve better. So do the doctors who’ve dedicated their lives to caring for them. We need a Medicare payment system that recognizes the value of independent physicians and the trust they build with their patients over time. And we need Congress to step up—because unless something changes, we’re going to keep losing the kind of doctors who make health care feel human.

About the Author

Terry Wilcox is executive director of Patients Rising, a nonprofit patient education and advocacy organization that helps patients get access to essential diagnostics and treatments. Wilcox founded Patients Rising in 2015 after spending more than a decade in advocacy for cancer patients.

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