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Primary Care Visits Are Down: Is That Good or Bad for Patients?

Urgent care and retail clinics are becoming popular alternatives to the doctor's office

Mature Woman In Consultation With Female Doctor Sitting On Examination Table

Monkey business images/getty images

En español | Fewer adults are going to a doctor's office for routine primary care, and experts say cost and convenience could be to blame.

Between 2008 and 2016, primary care visits dropped by about 24 percent among insured adults ages 18 to 64, a new report in the journal Annals of Internal Medicine finds. By 2016, nearly half of adults in the study went an entire year without seeing their doctor — and this is a trend that is happening “across the board,” says the study's corresponding author Ishani Ganguli.

"People are looking to primary care to solve a lot of problems that we have,” says Ganguli, an assistant professor of medicine at Harvard Medical School and an internist at Brigham and Women's Hospital in Boston. “Primary care is linked to having better health outcomes, lowering your likelihood of needing to use the emergency department, lowering your medical costs and even lowering your risk of dying … yet people are not seeing their primary care doctors much.”

Reasons behind drop in doctor's office visits

The study highlights several potential explanations for why traditional doctor's visits are down, the first being cost. While routine checkups tend to be covered by insurers, out-of-pocket payments for appointments pertaining to certain illnesses or conditions — think knee pain or diabetes complications — have been going up, Ganguli says, leaving people with high-deductible insurance plans on the hook for a bigger bill.

Another possible reason: Patients with conditions that typically don't warrant a prescribed treatment, such as pink eye or the common cold, could be finding answers to their ailments online or over a quick email exchange with their doctor, she says. Primary care visit rates decreased sharply for everyday illnesses, the study found.

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Finally, more people are accessing medical care in nontraditional spaces, such as urgent care centers and retail clinics that don't require appointments and might end up costing less out of pocket. Visits to alternative health care venues increased by almost 47 percent during the study's nine-year period.

Primary care doctors look at ‘whole’ health picture

While these nontraditional settings can be convenient when you need something “specific,” such as a strep test, Ganguli warns against replacing primary care with a model that provides less continuity. Primary care doctors are trained to think about the “whole person,” not just a person's current condition, she explains. They keep patients up to date on immunizations and screenings, including mental health checkups. Primary care providers also help patients manage chronic conditions and all the medications that come with each diagnosis, especially as they age.

That said, the movement away from primary care is a “signal and a wake-up call” to change the current model to better fit patient needs, Ganguli says. Some practices are starting to do this with weekend hours, online scheduling and expanded care teams that can accommodate more patients.

Insurers can also play a role. Free and lower-cost primary care visits may help encourage people to use preventive medicine more, she adds. “The goal is: Let's make it easier to use primary care in a way that's good for you as a patient.”

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