Why Don't Young People Have Primary Care Physicians?

And why should finding one be a priority for all young adults?

October 14, 2021

"You should talk to your doctor about that" is a refrain that feels familiar. We've heard it in the commercials telling you to "Ask your doctor about Claritin" or to "Consult your doctor to make sure your heart is healthy enough for sex." Even the CDC recommends talking to your healthcare provider if you have questions about the COVID-19 vaccine.

But for many young Americans, the notion of "your doctor" is a foreign one. Who is "my doctor" and why do I even need one? Countless young Americans have decided that they don't, as a recent survey revealed that 45% of Americans between the ages of 18-29 don't have a primary care physician (or "PCP").

Why don't young adults have PCPs?

But why? Why has the newest cohort of adults decided to reject the status quo and skip primary care physicians for more convenient solutions?

Countless young adults, when leaving home for the first time, leave the practice of having a primary care physician at home with the remnants of their dying childhood. With mom and dad no longer scheduling doctor's appointments and physicals no longer required for their high school activities, the relationship between patients and their childhood primary care doc naturally fizzles out as high school graduates head off to college.

And many of those young adults aren't finding new primary care doctors.

But if you really think about, why would they? The post-high school years are, for many, a rush of change, excitement, and, often, a lack of funds. Developing a primary care relationship doesn't exactly feel like a priority when you're just trying to get through finals or land that summer internship, and for many young adults that leaves the reasons not to find a PCP outweighing the reasons to find a PCP.

The major reasons young adults don't find a PCP include the following:

Reason #1: The Convenience Revolution

The world within which today's young adults grew up in is completely different than that of their parents. Instead of hailing a taxi, today we request an Uber. Instead of buying a CD, we stream on Spotify. And instead of scheduling a doctor's appointment, we go to the urgent care. Why would we schedule an appointment for 2 days from now, when we're a quick Google search away from sitting across from an urgent care doctor 45 minutes from now?

The convenience revolution is firmly here, and a convenient patient experience is no longer a nice added benefit, but a necessity. In many cases, young adults, more so than older generations, value convenience over all else.

Reason #2: The Instability

For young adults, life often isn't exactly stable. Moving out of mom and dad's crib brings with it a plethora of bills and new sense of uncertainty. And having a PCP can feel like a thing for the "settled down" adult, not the adult still "finding themself." Who knows where they will be next year? They could be working a job across the country, in graduate school in a neighboring state, or backpacking through South America! The world is their oyster, why put the energy into developing a relationship with a doctor they might never see again?

Reason #3: The Expense

Many patients report that urgent care is cheaper. For example, a trip to the urgent care might cost them $40 and 15 minutes of their time. Primary care on the other hand, can cost significantly more in both dollars and time, as it may require multiple visits and referrals to specialists to obtain the proper treatment. Regardless of whether choosing urgent care over primary care is or isn't cheaper in the long run, what matters is its perceived expense. And many young adult patients simply believe that urgent care is cheaper, and that drives their decision-making.

Reason #4: The Lack Of Understanding

Frankly, the biggest reason seems to be that young people don't understand WHY they should have a primary care physician. Many think it's an outdated part of an antiquated system. All the doctors are looking at the same charts, right? Why do they need to see the same one every time?

The combined result of these factors is a generational shift away from primary care physicians. While the shift is understandable, it's based on a complete misunderstanding of the benefits of primary care physicians. The "why" of primary care is not actually about convenience or expense, it's about better health outcomes.

Why should young adults find a PCP?

The benefits of primary care are numerous, and there's evidence to back it up. To start, you lessen your likelihood of visiting the hospital or emergency room by having a primary care physician. You're also much likelier to be satisfied with your healthcare experience if you have primary care physician. Plus, in the long run, primary care can be cheaper. With a primary care physician overseeing your healthcare, you obtain a more comprehensive level of service. You have the opportunity to avoid unnecessary or duplicative testing, get in front of potential ailments with preventative screenings, and decrease hospitalizations. And research has shown that comprehensive care from family physicians is associated with lower patient costs!

So if you want to be more satisfied with the healthcare you receive, avoid pricey hospital visits, and decrease your overall healthcare spend, finding a primary care physician is a great decision. Still, these benefits don't even mention the most important benefit of primary care physicians: higher quality outcomes.

Primary care leads to better outcomes for patients. How so? Through a holistic, patient-centric, continuous approach. Dr. Natasha Bhuyan of the University of Arizona College of Medicine adeptly described the benefits of primary care as follows:

It's a PCP who can support a patient through behavioral change, like decreasing alcohol use. It's a PCP who can link a patient's insomnia to their underlying anxiety disorder or detect and address their risk of diabetes. It's a PCP who can have a thoughtful conversation with a patient about why they don't need an MRI for their headache.

Continuous care also matters in piecing through episode care. I recently met a new patient who had multiple, one-time visits at different urgent cares for fevers and sore throats. Through testing in our office, we found out he actually had HIV. ...

What differentiates primary care is not just what we do for patients -- it's our philosophy of care. Primary care is not just about ordering vaccines and screening for cancer. The primary care philosophy is to care for every patient. We are adaptable. We evaluate evidence and avoid unnecessary tests, but engage in shared decision-making and respect patient autonomy. We believe research should include a breadth of clinical patients. Health care delivery should continually evolve while keeping patients at the center. Through this approach, we can make a real impact on the health care system as well as on individual patients. And that includes the young, healthy one
s, too.

My experience

Transparently, what led me to write this article was my own, ongoing, experience with primary care. I was like many young adults, content to visit the urgent care when I had a major issue. I didn't see the need of "scheduling an appointment" when I could see a doctor within the hour if I had a real need.

But then I had a question about the COVID-19 vaccine and how my health history might affect its impact on my body. I was pretty nervous and really wanted a doctor's opinion, but I didn't know who to turn to... I would have felt silly walking into an urgent care to ask some doctor if my heart was healthy enough for the vaccine. Fortunately, some smart friends encouraged me to establish a relationship with a primary care physician and ask them. So I did.

And what I thought would be a long-drawn out process was actually surprisingly fast! Within a week I was chatting with my PCP. I was reviewing my health history with her, explaining the lingering issues I'd been dealing with, and asking the questions that would have felt silly to ask to an urgent care doctor. What I thought would be a quick 30 minute appointment turned into a two-hour discussion with a healthcare professional that I felt really cared about getting to know me and keeping me healthy. My PCP made some referrals and recommendations, and then scheduled a follow up appointment.

Since then, I've gone back for another appointment and left with a game plan for dealing with some issues I'd put on the backburner for too long. And while this could easily start to feel overwhelming, it doesn't because I know that my PCP has my back. I have a resource that I can call if I have questions, and that will have the context necessary to provide a good answer.

At the end of the day, it's really comforting. So, do yourself a favor and make an appointment with a primary care physician ASAP. It might feel silly going to the doctor when you're "not sick," but you'll feel much sillier when you're spending the night in the hospital due to an ailment your non-existent primary care physician would've identified if you'd only bothered to make an appointment.

Don't wait. Do it now. Future you will thank you for it.

Appendix
Published on: 
October 14, 2021

Note: This is not to be taken as tax, legal, benefits, health or financial advice. Since rules and regulations change over time and can vary by location, consult a lawyer or financial expert for specific guidance.

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