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


  • McKinlay, John
  • Marceau, Lisa


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).

Suggested Citation

  • McKinlay, John & Marceau, Lisa, 2008. "When there is no doctor: Reasons for the disappearance of primary care physicians in the US during the early 21st century," Social Science & Medicine, Elsevier, vol. 67(10), pages 1481-1491, November.
  • Handle: RePEc:eee:socmed:v:67:y:2008:i:10:p:1481-1491

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    References listed on IDEAS

    1. repec:mpr:mprres:3869 is not listed on IDEAS
    2. Murray, Joanna & Shepherd, Simon, 1993. "Alternative or additional medicine? An exploratory study in general practice," Social Science & Medicine, Elsevier, vol. 37(8), pages 983-988, October.
    3. David Cutler & Ellen Meara, 2001. "Changes in the Age Distribution of Mortality Over the 20th Century," NBER Working Papers 8556, National Bureau of Economic Research, Inc.
    4. Potter, Sharyn J. & McKinlay, John B., 2005. "From a relationship to encounter: an examination of longitudinal and lateral dimensions in the doctor-patient relationship," Social Science & Medicine, Elsevier, vol. 61(2), pages 465-479, July.
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    Cited by:

    1. McKinlay, John B. & Marceau, Lisa D., 2012. "From cottage industry to a dominant mode of primary care: Stages in the diffusion of a health care innovation (retail clinics)," Social Science & Medicine, Elsevier, vol. 75(6), pages 1134-1141.
    2. Martin, Graham P. & Currie, Graeme & Finn, Rachael, 2009. "Reconfiguring or reproducing intra-professional boundaries? Specialist expertise, generalist knowledge and the 'modernization' of the medical workforce," Social Science & Medicine, Elsevier, vol. 68(7), pages 1191-1198, April.
    3. Siegrist, Johannes & Shackelton, Rebecca & Link, Carol & Marceau, Lisa & von dem Knesebeck, Olaf & McKinlay, John, 2010. "Work stress of primary care physicians in the US, UK and German health care systems," Social Science & Medicine, Elsevier, vol. 71(2), pages 298-304, July.
    4. Foster, Drew, 2016. "‘Keep complaining til someone listens’: Exchanges of tacit healthcare knowledge in online illness communities," Social Science & Medicine, Elsevier, vol. 166(C), pages 25-32.


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