Family medicine is in decline
Family medicine and primary care are increasingly hard to access in North America, with many people reporting months-long waits for new patient and specialist appointments even in large urban areas. Commenters point to physician shortages, burnout, post-COVID retirements, private-equity-driven consolidation, and heavy administrative and insurance burdens as drivers that push doctors away from traditional family practice toward specialties, concierge models, or out of medicine altogether. In response, care is shifting to urgent care centers, nurse practitioners, direct primary care memberships, and even overseas treatment, raising questions about continuity of care, equity, training standards, and how systems should adapt to aging populations and rising chronic illness.
Primary care access & wait times
- Many US commenters report months-long waits for new PCPs and specialists, even in large metros; some cite 6+ month waits and needing to travel far or go out-of-network.
- Others say they can get PCP/NP appointments in days or weeks, especially outside dense urban cores or via cancellation lists.
- There’s disagreement over whether very long waits are “unusual”; some argue national averages hide large geographic and specialty variance.
- Practices often “rate-limit” new patients, leading to months-long delays for first visits but faster follow-up for established patients.
Structural causes & consolidation
- Widespread perception of a primary care physician shortage and worsening specialist availability post‑COVID.
- Small independent practices are being squeezed by billing, EHR, and compliance overhead and bought by large networks or private equity; efficiency and profit are seen as crowding out doctor–patient relationships.
- Physician burnout is common; some leave clinical practice early, citing loss of autonomy to administrators.
Role of NPs/PAs and task shifting
- Many report being seen increasingly by nurse practitioners or physician assistants instead of doctors, especially in pediatrics and routine primary care.
- Some see this as appropriate for healthy patients and cost control; others report poor advice and worry about “scope creep” and lower training levels.
- There’s debate whether extensive physician training is overkill for front-line primary care or essential for quality and safety.
Patient workarounds & alternative models
- Workarounds include urgent care as de facto PCP, telemedicine (mixed reviews), concierge/direct primary care memberships, and using large systems’ NPs for access.
- Some suggest medical tourism (e.g., Mexico, Southeast/East Asia) for fast, cheaper specialist care and procedures.
- A few mention self-ordered labs and desire for AI or better decision-support tools for self-triage between long waits.
Costs, insurance, and incentives
- US participants describe very high total annual costs (premiums, deductibles, out-of-network care), even with “good” employer plans.
- ACA marketplace subsidies significantly reduce premiums for some, but employer plans can be far more expensive and opaque.
- Insurance design (HDHPs, referral rules) and PE-owned networks are seen as distorting incentives and contributing to access problems.
Aging, disability, and post‑COVID effects
- Commenters highlight growing needs of an aging population without family caregivers, shifting burdens onto healthcare systems.
- More disability claims and forms are attributed to long COVID and pandemic-era mental health issues, though the exact contribution is viewed as unclear.