Primary-care shortage leaves millions without doctors

One in five Americans does not have a family doctor, and even many who do are often shut out of care, translating to higher rates of illness and death, and higher costs.

A Scripps Howard News Service review found that access to primary care is deteriorating, driving millions of people outside traditional family practices, or leaving them without care. Millions of people — even with insurance — often find it impossible to see a doctor except in an emergency room or walk-in clinic.

In some places, the absence of care is stark — like the 148 mostly rural counties with no doctor at all, according to government records analyzed by Scripps Howard.

The Scripps Howard analysis compared the number of primary-care doctors in each county with the number of deaths and found a clear, consistent pattern:

Counties with more primary-care physicians had lower death rates than those with fewer family doctors. They also had a lower rate of death from preventable diseases like hypertension, heart disease and colon cancer.

The death rate from hypertension — elevated blood pressure that usually can be controlled through diet, exercise and medicine — is 32 percent greater in the counties with the fewest doctors when compared to the counties with the highest number of doctors.

The jurisdiction with the highest rate of reported hypertension-related death, Georgia's Randolph County, which government records show has only one general practitioner serving a population of more than 7,300. Fifteen percent of all deaths in that county in 2005 were from hypertension. In second place is rural Cottle County, Texas, which has no doctors at all.

"Analyses of the impact of access to primary care are all consistent in showing that the greater the access to primary care and the better the quality of primary care, the better the health," said Dr. Barbara Starfield, a professor of health policy and management at Johns Hopkins University.

Although the government counts more than 326,000 doctors in some area of primary care, there are not enough frontline physicians in thousands of communities, with many leaving the field or cutting back because of long hours, high patient loads and inadequate payments. And only a handful of new doctors are training to enter primary care.

"The shortage of general internists is a recurring theme in every state I have visited," said Dr. Jeffrey Harris, president of the American College of Physicians. "Behind the data are thousands of communities and millions of patients not getting the care they need."