Since the beginning of the pandemic, the shortage of nurses in the United States has become devastatingly apparent. But nurses aren’t the only healthcare workers in limited supply in the U.S. 

The number of primary care doctors has also declined in recent decades despite soaring demand for their services, says Tim Hoff, professor of management, healthcare systems, and public policy at Northeastern. Just as it brought attention to the nurse shortage, the pandemic is highlighting this other hole in the healthcare system. 

Hoff, who is the author of Next In Line, a book about the importance of patient-doctor trust, believes the lack of long-term relationships between patients and doctors could affect people’s willingness to receive a COVID-19 vaccine. 

“There are people who don’t trust the safety of the vaccine. They need an expert voice to answer their questions and help them get past their anxieties,” says Hoff, who recently wrote an article on the subject in Medical Economics.  

Hoff remembers one instance when he was in this exact position. His son was supposed to receive multiple vaccines during one doctor’s visit, and Hoff had questions about whether receiving all of the immunizations in a short period of time was safe. 

“We discussed it for about 20 minutes, but if I hadn’t had that conversation with a doctor I already trusted, I might not have let my son get all those vaccines at once,” Hoff recalls.

Primary care doctors are becoming more scarce partially because of the trend toward alternative healthcare facilities such as retail health clinics or urgent care centers. “For a lot of people, these are cheaper and more convenient,” Hoff says. “But there’s no relationship formed between the patient and the provider in these one-off visits.” 

This trend could also exacerbate the vaccine hesitancy problem currently afflicting the U.S. (27 percent of Americans say they probably or definitely won’t get the vaccine). Most vaccines will be administered in pharmacies and pop-up clinics where care providers and patients have no prior relationship.  

“Even if we wanted to get these vaccines at our doctor’s office, they might not be available there,” Hoff says. “In a lot of cases, the only places that have the ability to store the vaccines are chain pharmacies or hospitals.”  

Pfizer’s COVID-19 vaccine, which is now being distributed in the U.S., must be kept at -80 degrees Celsius in expensive freezers that some smaller doctor’s offices might not own. 

“You don’t really get to ask many questions in this type of setting,” Hoff continues, referring to pop-up clinics. “It’s just a place to get a shot. You don’t have a provider you know who you can ask. And if you’re already on the fence about the vaccine, this might be enough to deter you.”

Another reason primary care doctors are less abundant now is the stigma associated with the title and the low salary compared with other healthcare positions, Hoff explains. “There’s a negative connotation for becoming a family doctor. Med students call the position a ‘consolation prize’ for not getting into other clinical specialties.” 

All the hours spent on paperwork and the intense communication associated with a family medicine job is a turnoff for some aspiring doctors, Hoff continues. Plus, the salaries are much lower than those earned by specialty doctors, such as dermatologists, who usually treat isolated issues. 

“Primary care is paid a lot less for arguably more work,” Hoff says. The cost of school is also a factor. “Why become a primary care doctor when you could become a nurse practitioner or a physician assistant in much less time.” 

A lack of primary care affects people’s health far beyond just COVID-19, though, Hoff says. “Compliance for everything health-related goes way down when people don’t have relationships with their doctors. The research shows that people with chronic illness are less likely to follow their treatment regimens, take their medications, and generally lead healthy lifestyles.” 

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