ARE PATIENTS BECOMING SMARTER?

Maybe. Unless you have health insurance that requires you to see your primary care doctor (family physician, pediatrician, internist) first, before you see a specialist, many Americans have educated themselves well enough to bypass the GP and go directly to the specialist who takes care of their specific problem. This trend of better-educated, more medically-sophisticated patients has resulted in fewer visits to primary care practices. A survey compiled from data from the “Medical Expenditure Panel,” an agency in the U.S. Bureau of Labor Statistics, showed that from 2010 to 2021, “ambulatory care visits to PCP’s declined by 43%”….and to internists by 22%. The years 2019 to 2021, the height of the COVID-19 pandemic, saw the greatest decline. During the same time period, “the proportion of visits to nurse practitioners and physician assistants increased by 98%.” The other factor is that during COVID-19,  physicians adopted the awful telemedicine farce. Patients visited the doctor via a safe, remote, and impersonal internet connection that allowed verbal and visible communication but little else. 

On the other hand, “preventive care visits increased for all physician types, with PCP’s seeing a 25% rise,” while “acute and chronic care visits to PCP’s decreased by 30 and 20%, respectively.”

Are these decreases due COVID? Are these decreases due to patients having a new awareness of the specialty physician they need to see? The article does not fill in those blanks. I’d like to assume it’s both. Patients are indeed smarter, patients read about their problems on the internet, physicians defer ambulatory care visits to their subordinate NP’s and PA’s freeing their time for preventive care and complex chronic problems. “Adults with two or more chronic conditions were more likely to receive care from PCP’s than NP’s or PA’s.”

Family physicians need to improve their knowledge and proficiency in caring for the variety of problems they are presented. When patients feel confident of their PCP’s abilities, better rapport is established and more competent care is delivered. During the COVID-19 pandemic, doctors abandoned their responsibility to their patients and foisted it upon Emergency Medicine specialists and other physician extenders. It was a dark era for the medical profession. Fortunately, it’s over, and common sense medical care has resumed. The regrettable telemedicine fiasco is now an afterthought. 

I think if PCP visit statistics were revisited, we would see an increase from 2022 to the present. It still may be, however, that patients have become smarter and self-refer to specialists for their problems. Most PCP’s know their limits, but if patients gave their PCP the opportunity to evaluate their problem, I think competent, and more personal care would be the outcome. 

Reference: Talwadekar M. Are Primary Care Physician Visits Declining in the US Healthcare System? Medscape Medical News 2025 February 26.