{"id":435924,"date":"2025-12-09T16:06:38","date_gmt":"2025-12-09T16:06:38","guid":{"rendered":"https:\/\/www.europesays.com\/us\/435924\/"},"modified":"2025-12-09T16:06:38","modified_gmt":"2025-12-09T16:06:38","slug":"primary-care-physicians-around-the-main-line-are-a-dying-breed","status":"publish","type":"post","link":"https:\/\/www.europesays.com\/us\/435924\/","title":{"rendered":"Primary Care Physicians Around the Main Line Are a Dying Breed"},"content":{"rendered":"

Dr. Andrew Lipton\u2019s parents maintained a modest lifestyle in Penn Valley. The revenue from the small chain of gift shops they ran put their son through medical school, and he became an osteopathic family doctor with a decades-long practice. At Narberth Family Medicine and Acupuncture Center<\/a>, Lipton\u2019s business model continues to serve him well in an ever-changing healthcare industry.<\/p>\n

Increasingly, though, Lipton is the exception. In short, many primary care physicians have had it. They get all the work but little to none of the financial rewards. Many practitioners in general, family or internal medicine are repurposing or retiring early. The third option is accepting a buyout from one of the health networks swallowing up the dwindling number of independents beset with the escalating costs and burdens of running a private practice. \u201cIt\u2019s overwhelmingly expensive,\u201d says Lipton. \u201cAn EKG machine alone costs thousands\u2014or you can join Main Line Health \u2026 where you don\u2019t need to also be an entrepreneur.\u201d<\/p>\n

In the early 1980s, three-quarters of doctors in the United States owned their own practices. Today, fewer than half do. The push to moderate costs has led hospitals to start buying up practices, initiating managed care of the patient\u2019s comprehensive needs across an entire health system. It makes sense, then, to integrate physicians into those networks. But the trend has also led to a less personal approach.<\/p>\n

Lipton has teamed with his wife, acupuncturist Mary Ann Settembrino. Together, they make a reasonable living. In more than a decade in primary care, he\u2019s had just one resident who wanted to go into private practice. \u201cBut she also had a husband\/partner with finances,\u201d he notes.<\/p>\n

These days, it\u2019s rare for a medical student to consider a career as a primary care physician. The shortage on both ends is snuffing out what was once the cornerstone of medical treatment\u2014the patient-doctor relationship. There was a time when family physicians were integral and revered community members. They might\u2019ve seen 50 patients a day. Some of us may be old enough to even remember house calls.<\/p>\n

Since then, the number of Americans with a personal physician (traditionally the first point of contact in the healthcare system) has been steadily declining, particularly for younger patients. As of 2018, nearly half of adults under 30 didn\u2019t have a primary care doctor\u2014and that was seven years ago, pre-Covid. Even PCP terminology is troublesome, as \u201cprimary\u201d has two conflicting definitions. It can mean either \u201cthe foundation of the rest of it or the first level and not so important,\u201d says Dr. Christine Laine, who lives in Wynnewood and teaches in the internal medicine departments at both Jefferson and Sidney Kimmel medical colleges in Philadelphia.<\/p>\n

\"doctorsIllustration by Jon Krause<\/p>\n

\n

\u201cTHERE\u2019S SIMPLY MORE MONEY AND STATUS TO BE HAD AS A SPECIALIST IN CARDIOLOGY, ONCOLOGY, PULMONOLOGY AND OTHER FIELDS.<\/p>\n<\/blockquote>\n

Laine does her part to try to convince residents of the rewards of becoming a generalist. Meanwhile, younger patients are opting for the convenience of urgent care and retail-style clinics, emergency rooms, and even AI-powered self-diagnosis. It\u2019s all \u201cpatchwork\u201d to Laine, who\u2019s also editor-in-chief of the \u201cAnnals of Internal Medicine,\u201d a publication of the Philadelphia-based American College of Physicians, one of the professional organizations charged with changing current perceptions. \u201cBut it\u2019s hard to convince 20-somethings,\u201d she says.<\/p>\n

Increasingly, the nurse practitioner has become the physician\u2019s proxy. But it\u2019s \u201cshortsighted to think you can replace PCPs with them,\u201d says Laine.<\/p>\n

Laine sees the potential restoration of the field as complex and multilayered. At the forefront: more equitable compensation between PCPs and specialists. \u201cIt\u2019s no big mystery why medical school students aren\u2019t going into primary care,\u201d she says.<\/p>\n

There\u2019s simply more money and status to be had as a specialist in cardiology, pulmonology, nephrology, oncology and other fields. Either that, or you allow yourself to get gobbled up by health systems and corporate entities.<\/p>\n

According to a recent report from the nonprofit healthcare research foundation Milbank Memorial Fund, one in three U.S. doctors still practices primary care\u2014but among young physicians two years into their careers, the share is one in five. The Association of American Medical Colleges projects a shortage of as many as 48,000 primary care doctors by 2034.<\/p>\n

\u201cThe top question I get is, \u2018Can you find me a PCP?\u2019\u201d says Laine, who had to tap the \u201cfavor bank\u201d to get one for herself. \u201cThe ones in practice are busy and full. It should actually strike fear in your heart to learn that your physician is retiring.\u201d<\/p>\n

Dr. Peter Edde was the first in his family to attend college, let alone medical school. \u201cGrowing up, I knew doctors came and healed you,\u201d says Edde, who was born and raised in Lebanon and currently practices internal medicine at Penn Medicine Radnor. \u201cI wanted to do that, pursued it and have enjoyed the path\u2014a straight family-medicine track.\u201d<\/p>\n

After earning his degree from the American University of Beirut Faculty of Medicine and completing a one-year residency at home, Edde came to Norristown for a full residency at Montgomery Family Practice. He\u2019s a 20-year veteran of a service model he knows is in flux. \u201cThe encounter has become different, and so has the patient experience,\u201d he says. \u201cNow, you\u2019re not talking to patients so much as talking to the computer. You\u2019re gathering information from the exam, but you\u2019re also drawn to the computer. There can be minimal eye contact, and a relationship can get lost. It\u2019s become more mechanical and less clinical.\u201d<\/p>\n

Something else may be lost under the new model. One recent study found that when patients begin to distrust or drop their longtime primary care doctor, their emergency room visits and hospital admissions increase along with their mortality rate. At Edde\u2019s Penn Medicine practice, physicians have a half hour to see each patient. \u201cThe job\u2019s harder depending where you\u2019re practicing and how well organized that system is,\u201d he says. \u201cDemands, expectations and administrative burdens can be more, but if you\u2019re surrounded with the right team, it can make it better.\u201d<\/p>\n

Among the 16 practitioners at his office, Edde is one of 10 in primary care. His group is divided into small teams of two to four physicians and one or two nurse practitioners. \u201cWe don\u2019t just want to see patients and get paid\u2014we want to see them and manage their care to keep them as healthy as possible,\u201d Edde says. \u201cWhen we manage healthcare as much as possible, the patient, the healthcare industry and the insurance companies all win.\u201d<\/p>\n

And the only way to survive may be to join a large institution, as Edde has done. It means a guaranteed salary, paid vacation and other perks. \u201cI\u2019ve met others in private practice who say they haven\u2019t gone on vacation in 14 years,\u201d Edde says. \u201cTo survive, they need to do extra things.\u201d<\/p>\n

That\u2019s exactly where Lipton\u2019s found himself. \u201cStarting from day one, I didn\u2019t want to be anyone\u2019s employee,\u201d he says. \u201cWhen you come from an entrepreneurial background, you don\u2019t want to be employed. It\u2019s harder to be stubborn, so it\u2019s not for everyone.\u201d<\/p>\n

A half dozen associate medical practitioners have come and gone after short stays at Narberth Family Medicine and Acupuncture Center. \u201cThe extra work falls on the primary care physician, never on somebody else,\u201d Lipton says. \u201cIt\u2019s the time and money spent.\u201d<\/p>\n

\"DRCourtesy of Lauryn Swavely<\/p>\n

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\u201cTHE ASSOCIATION OF AMERICAN MEDICAL COLLEGES PROJECTS A SHORTAGE OF AS MANY AS 48,000 PRIMARY CARE DOCTORS BY 2034. \u201cTHE ONES IN PRACTICE ARE BUSY AND FULL,\u201d SAYS DR. CHRISTINE LAINE. \u201cIT SHOULD ACTUALLY STRIKE FEAR IN YOUR HEART TO LEARN THAT YOUR PHYSICIAN IS RETIRING.\u201d<\/p>\n<\/blockquote>\n

Recently, Lipton\u2019s expenses have skyrocketed. Before the pandemic, he could hire a medical assistant for $12-$15 an hour. Today\u2019s rate is $19-$20. And rent keeps going up. \u201cThe writing is on the wall,\u201d he says. \u201cI\u2019m 62. I love what I do. But how can I run a business if costs keep going up and [patient, Medicare and insurance] payments keep going down?\u201d<\/p>\n

As a way to stay in business while gradually moving toward retirement, Lipton is actively researching how to convert his practice into a more financially feasible membership or concierge model. For the patient, this involves an upfront fee\u2014a retainer of sorts that provides a steady source of pre-paid income. It\u2019s a national trend that\u2019s growing in popularity, with an estimated 1,300 U.S. practices. But it only serves a small, more affluent percentage of the population, maybe 400,000 patients.<\/p>\n

\"DRCourtesy of Narberth Family Medicine and Acupuncture Center<\/p>\n

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DR. ANDREW LIPTON IS ACTIVELY RESEARCHING HOW TO CONVERT HIS PRACTICE INTO A MORE FINANCIALLY FEASIBLE MEMBERSHIP OR CONCIERGE MODEL.<\/p>\n<\/blockquote>\n

Any change of that nature, however, would bump Lipton out of the system. \u201cIt might eliminate 60 to 70% of my patients,\u201d he says. \u201cSome call it elitist because only the wealthy can see you. I have patients in their 80s on Medicare, and I\u2019ll feel guilty if this drops them or they drop me.\u201d<\/p>\n

But Lipton also sees the benefits. \u201cI\u2019m asking my patients to buy into what I do like a lawyer is retained to figure out your case,\u201d he says. \u201cYou don\u2019t have to join, so it excludes me from legal repercussions.\u201d<\/p>\n

Ideally, Lipton hopes it would be enticing for enough patients. \u201cI want to present an offer you can\u2019t refuse and hear, \u2018I like you. I like what you do, so why wouldn\u2019t I join?\u2019\u201d he says.<\/p>\n

It\u2019s also a solution that could help stave off active venture capitalists who often encroach with offers to buy the practice. \u201cIf I don\u2019t make some sort of move, I\u2019ll either fail or retire,\u201d says Lipton.<\/p>\n

Related: Menopause on the Main Line: Local Experts Offer Support<\/a><\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"Dr. Andrew Lipton\u2019s parents maintained a modest lifestyle in Penn Valley. The revenue from the small chain of…\n","protected":false},"author":3,"featured_media":435925,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5132],"tags":[5229,1448,2830,1311,67,586,132,5230,68,2969],"class_list":{"0":"post-435924","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-philadelphia","8":"tag-america","9":"tag-pa","10":"tag-pennsylvania","11":"tag-philadelphia","12":"tag-united-states","13":"tag-united-states-of-america","14":"tag-unitedstates","15":"tag-unitedstatesofamerica","16":"tag-us","17":"tag-usa"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@us\/115690471306293300","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/435924","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/comments?post=435924"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/435924\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media\/435925"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media?parent=435924"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/categories?post=435924"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/tags?post=435924"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}