‘Where have all the doctors gone?’

By Dennis Archambault

This is the headline of the lead article in the January 2025 issue of AARP Bulletin. But it’s a headline that has occurred repeatedly over several years. Most recently, “Where are all the Pediatricians?” was the title of an article in the Journal of the American Medical Association in July 2024. And in an age of heightened anxiety, Healthcare Brew asked this question, “Why is there a psychiatrist shortage?”. It addresses the extensive physician shortage, highlighting the problem of primary care.
Actually, it’s not just a problem; it’s a crisis, writes Howard Zucker, M.D., author of the AARP article. “The average wait for new patients to see a physician is 26 days, and that’s for mostly healthy people. In a medical emergency, the situation can be even more frightening: 22 percent of acutely ill patients 65 or older who sought medical attention had to wait six days or more for an appointment… This is a crisis. And it’s a crisis that’s getting worse, rapidly.”
Dr. Zucker underscores the importance that primary care plays in health maintenance. “It is the primary care provider (PCP) who provides the annual checkups that may detect problems early on, and who serves as the gatekeeper for referrals to specialists. Many people with private insurance, as well as those enrolled in Affordable Care Act plans, are required to see a PCP before they can access specialists in a majority of fields.”
This crisis did not occur overnight. It existed when the Affordable Care Act embraced the Teaching Health Center concept of training primary care physicians 15 years ago. The program addressed the well-documented primary care shortage and added an element of urgency: the shortage in underserved communities and vulnerable populations. Unlike the traditional method of hospital-based ambulatory care training, primary care physicians in teaching health centers do most of their clinical work in health centers, not hospitals. As a result, they’re more inclined to establish their practices there. Authority Health has the second-largest teaching health center program in the nation, training 78 physicians.
In the journal Academic Medicine, Drs. Fitzhugh Mullan, Candice Chen, and Frederick Chen noted that teaching health centers represent “a significant departure from the Medicare GME funding system. It provides payments to ambulatory care centers for both direct and indirect GME expenses and mandates a level of reporting from recipients that is not required for Medicare GME support.” Teaching Health Centers, they said, train primary care residents in relevant models through “interprofessional teams and patient-centered medical homes, developing educational initiatives that address primary care practice in underserved areas, and transforming organizational and funding structures to support community-based training.”
Currently, the Teaching Health Center Program, along with Federally Qualified Health Centers and the National Health Service Corps. have been petitioning Congress to reauthorize funding for their programs – which are essential for the health care safety net. Funding for the programs expired in September 2024 but was temporarily extended through mid-March.

Dennis Archambault is vice president of Public Affairs for Authority Health.