Family medicine is in decline

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.