Issues like poor quality of life, low salary, and inconvenient location can contribute to a primary care shortage. Lack of access to general practitioners and other primary care providers can, in turn, create a decline in patient outcomes and general level of health. In some regions, the government has designated specific communities as being of particular concern, and may offer incentives to care providers who agree to work in those areas. Other government programs may more generally address the issues that lead care providers to seek specialties rather than general primary care.
One important issue can be location. Rural, remote, and harsh areas are less appealing for medical practitioners. It can be difficult to attract and retain care providers to sites like rural Alaska, where the weather is unpleasant and there may be few cultural activities available. High cost of living can be another barrier, especially to new practitioners who may be struggling with loans taken out to pay for school. They could be effectively barred from practice in some areas because they are too expensive to live in.
Another issue can be low income in comparison to specialists. General practitioners tend to make much less than people like anesthesiologists and cardiologists. Students may be drawn to specialty care to make more money. In addition, reimbursement rates can be low, and a primary care provider may constantly be fighting with insurance companies and government benefits programs to get compensation for patient care. Difficulties with billing can contribute to a primary care shortage.
Working conditions can also be a factor. At times, people working in primary care may be expected to work long hours for minimal pay, including shifts in emergency or on-call environments. Long hours, limited flexibility for vacations and family time, and unpleasant working environments can add to a primary care shortage by making work in this area of medicine less appealing for practitioners. Changes to workplace policies can help address a primary care shortage, as can regulations mandating limitations on working hours for health care providers.
Concerns about malpractice can be another issue with a primary care shortage. Malpractice premiums can be high, especially for care providers operating out of their own offices and clinics, rather than under the umbrella protection of a hospital. It may not be feasible to maintain a practice and cover all the overhead expenses if the malpractice is high and the compensation rate is low. Consequently, doctors and other care providers may be priced out of participation in primary care.