Death of the Family Practice

Dr. Joseph Kasper is the kind of family physician who makes his patients feel like relatives. He'll talk politics, proudly show off his son's awards and discuss medical problems in such a way that people don't feel like just another number.

Like many family physicians, the preventive care he provides can save thousands of dollars for patients who don't wait for their maladies to become emergencies before they seek help.

But these days, it's tough to be an old-fashioned family doctor. It's even tougher to own your own practice, as Kasper can tell you — his West Jordan clinic closed after he sold it to try and pay the bills.

That's why, as health care reform is debated across the country and physician shortages loom, doctors are starting to warn: America's source of primary care may be fading away.

Losing the clinic was a blow to Kasper — both emotionally and financially. He's now employed at another practice, but the thought of ever starting over on his own makes him cynical.

"Never again," Kasper says with bitterness in his voice. "Not even going to waste the time."

The reputation of long hours, relatively low pay and potential for failure associated with primary care is enough to turn many doctors away from the field. At the same time, the population continues to grow, and more and more family doctors are retiring.

In the end, this means more Americans will have less access to primary care doctors. And less access could mean increased sickness and required costly treatments, doctors say.

It's estimated that by 2020, Utah will have a 40 percent reduction of its family physician work force, according to the Utah Medical Education Council. Nationwide, a deficit of 85,000 to 96,000 physicians is anticipated by 2020, according to the Council on Graduate Medical Education.

"There is something of a crisis in family practice, and doctors coming out of medical school have heard of these problems, and they're just not choosing family practice to go into," said Mark Fotheringham, Utah Medical Association spokesman. "You have to be really dedicated to the practice itself."

Although there is a growing need for primary care doctors in America, it is hard for them to establish their own practices, as the case of Kasper illustrates. More and more, hospital corporations and insurance companies are stepping in to hire physicians to work at company-owned clinics. In Salt Lake County, the competition is high, both with existing private practices and with company-owned clinics that have a steady stream of patients generated within their own network.