Traditional Practice


Physicians and patients are increasingly dissatisfied with the current state of overcrowded and impersonal practices as well as escalating costs and declining reimbursements. A typical doctor can only give about seven minutes of exam time to the majority of patients and most practices run significantly behind on appointments. A survey published in the Annals of Internal Medicine in 2009 shows 48% of physicians report working in “chaotic” environments and 30% claim they need twice as much time with each patient. According to the projected physician shortages by the American Board of Internal Medicine (ABIM), the American Academy of Family Physicians and the American Academy of Pediatrics, these stressed work conditions will deteriorate further. The ABIM also published in 2006 that the collapse of the current medical system is inevitable. They state “primary care is on death row.”


An aging and overworked physician population continues to retire or reduce work hours, and an insufficient number of new primary care doctors are being trained to meet a growing general population. Unfortunately, health care policy has not changed since 2006 to significantly ameliorate this crisis.

The majority of graduating physicians continue to select non-primary care subspecialties for the better work hours and greater income potential.

Government fiscal policy to reverse these trends is nearly absent. The imminent addition of 30 million previously uninsured patients to the healthcare system due to current healthcare legislation and the change to Accountable Care Organizations, combined with Medicare reimbursement cuts and an estimated doctor shortage of 150,000 physicians by 2025 will certainly increase dissatisfaction for all involved in health care.

The practical effect will be increased in delays for appointments, increased patient wait times in the doctor’s office, increased physician workload, and increased the utilization of midlevel practitioners, such as advanced registered nurse practitioners and physician assistants.

The working conditions are anticipated to be so difficult that the United Press International reported in June 2011 that less than one-third of U.S. physicians are expected to remain in private practice by 2013. This prediction came true – most physicians are now employed by hospitals or large corporations. This means doctors may be restricted in their practice patterns to serve patients in order to meet the overriding mission of the organization.