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Cited by 82Primary Care and Health OutcomesGlobal Health Workforce IssuesHealthcare Policy and Management

When there is no doctor: Reasons for the disappearance of primary care physicians in the US during the early 21st century

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McKinlay, John, Marceau, Lisa·2008·Social Science & Medicine
DOI 10.1016/j.socscimed.2008.06.034PMC PMC2757942
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Abstract

Primary care doctoring in the USA today (2007) bears little resemblance to what existed just 25 years ago. We focus on what is likely to unfold in the U.S. over the next several decades and suggest that by about 2025, primary care doctoring in the U.S. could be rare, possibly unrecognizable and even nonexistent. Seven reasons for the probable disappearance of primary care doctoring are identified. The most important reason is medicine's loss of state sponsorship: the U.S. state has shifted from a pluralistic orientation to a New Right approach. With less state protection medicine has become even more attractive for private interests. Six additional reasons include: (1) the epidemiologic transition (chronic diseases reduce doctors to a palliative role and monitoring of incurable conditions); (2) the overcrowded health care playing field (non-physician clinicians are supplanting primary care doctors); (3) the unintended consequences of clinical guidelines (the art of doctoring is reduced to formulaic tasks, easily codified and performed by non-physician clinicians); (4) the demise of the in-person examination (in-person examination is being replaced by impersonal testing); (5) primary care doctoring is becoming unattractive (physicians are dissatisfied, alienated and experiencing income declines. Applications by U.S. graduates to primary care programs continue to decline); (6) patients are not what they used to be (Internet access and Direct to Consumer advertising are changing the doctor-patient relationship). By 2025, many everyday illnesses in the U.S. will be managed via the Internet or by non-physician clinicians working out of retail clinics. Some medical problems will still require a physician's attention, but this will be provided by specialists rather than by primary care doctors (general practitioners).

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Research works printed but not linked: 7

  1. Alper PR The decline of family doctors Policy Review 2004 41 62
  2. Carr-Saunders AM Wilson PA The professions 1933 Oxford The Clarendon Press
  3. Freidson E Professionalism reborn: Theory policy and practice 1994 Chicago University of Chicago Press
  4. Krause E Death of the guilds: Profession, states and the advance of capitalism 1999 New Haven Yale University Press
  5. Landro L The new force in walk-in clinics The Wall Street Journal 2006 New York
  6. Light DW Countervailing power: The changing character of the medical professions in the United States 1993 New York Oxford University Press
  7. Stoeckle JD Gorall AH Mulley AG The tasks of primary care Primary care medicine 2006 5th ed. NY Lippincott Williams & Wilkins 1 6

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Authors
McKinlay, J., & Marceau, L.
Affiliations
New England Research Institutes (US)
Corresponding author
Marceau, Lisa
ORCID
Marceau, Lisa
Venue
Social Science & Medicine
Publisher
Elsevier BV
Published
2008-11
Volume
67
Issue
10
Pages
1481-1491
ISSN
0277-9536 (ISSN-L)
DOI
10.1016/j.socscimed.2008.06.034
PMC
PMC2757942
OpenAlex
W2014971075
Cited by
82
References
122
Citations by year
2026: 1 · 2025: 7 · 2024: 6 · 2023: 1 · 2022: 1 · 2021: 5 · 2020: 4 · 2019: 6 · 2018: 1 · 2017: 3 · 2016: 4 · 2015: 3 · 2014: 2 · 2013: 7 · 2012: 8
FWCI
14.78
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Social Science & Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Diabetes and Digestive and Kidney Diseases (R01DK066425)
Topics
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
  • Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
Keywords
primary care physician shortage, New Right, non-physician clinicians, clinical guidelines, physician-patient relationship, direct-to-consumer advertising, retail clinics, future of primary care
MeSH terms
Forecasting, Foreign Medical Graduates, Hospitals, Group Practice, Humans, Patient Acceptance of Health Care, Physician-Patient Relations, Physician's Role, Physicians, Family, Primary Health Care, Social Control, Informal, United States, Telemedicine, Internet

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