I hadn鈥檛 expected the tears.
My primary care doctor and I were saying goodbye after nearly 30 years together.
鈥淵ou are a kind and a good person,鈥� he told me after the physical exam, as we wished each other good luck and good health.
鈥淚 trust you completely 鈥� and always have,鈥� I told him, my eyes overflowing.
鈥淭hat means so much to me,鈥� he responded, bowing his head.
Will I ever have another relationship like the one with this physician, who took time to ask me how I was doing each time he saw me? Who knew me from my first months as a young mother, when my thyroid went haywire, and who since oversaw all my medical concerns, both large and small?
It feels like an essential lifeline is being severed. I鈥檒l miss him dearly.
This isn鈥檛 my story alone; many people in their 50s, 60s and 70s are similarly undergoing this kind of wrenching transition. A decade from now, at least 40% of the physician workforce will be 65 or older, according to If significant numbers of doctors retire, as expected, physician shortages will swell. Earlier this year, the AAMC projected an unmet need for up to 55,200 primary care physicians and 86,700 specialists by 2033, amid the rapid growth of the elderly population.
Stress from the covid pandemic has made the outlook even worse, at least in the near term. When the Physicians Foundation, a nonprofit research organization, in May and June, 61% reported 鈥渙ften experiencing鈥� burnout associated with financial and emotional strain. Two percent said they had retired because of the pandemic; another 2% had closed their practices.
Twenty-three percent of the doctors surveyed said they鈥檇 like to retire during the next year.
Baby boomers, like me, whose medical needs are intensifying even as their longtime doctors bow out of practice, are most likely to be affected.
鈥淭here鈥檚 a lot of benefit to having someone who鈥檚 known your medical history for a long time,鈥� especially for older adults, said Dr. Janis Orlowski, AAMC鈥檚 chief health care officer. When relationships with physicians are disrupted, medical issues that need attention can be overlooked and people can become less engaged in their care, said Dr. Gary Price, president of the Physicians Foundation.
My doctor, who鈥檚 survived two bouts of cancer, didn鈥檛 mention the pandemic during our recent visit. Instead, he told me he鈥檚 turning 75 a week before he closes the practice at the end of October. Having practiced medicine for 52 years, 40 as a solo practitioner, 鈥渋t鈥檚 time for me to spend more time with family,鈥� he explained.
An intensely private man who鈥檚 averse to publicity, he didn鈥檛 want his name used for this article. I know I鈥檓 lucky to have had a doctor I could rely on with complete confidence for so long. Many people don鈥檛 have this privilege because of where they live, their insurance coverage, differences in professional competence, and other factors.
With a skeletal staff 鈥� his wife is the office manager 鈥� my doctor has been responsible for 3,000 patients, many of them for decades. One woman sobbed miserably during a recent visit, saying she couldn鈥檛 imagine starting over with another physician, he told me.
At one point, when my thyroid levels were out of control, I saw my physician monthly. After my second pregnancy, when this problem recurred, I brought the baby and her toddler brother in a double stroller into the exam room. One or the other would often cry sympathetically when he drew my blood.
I remember once asking when a medical issue I was having 鈥� the flu? a sore throat? 鈥� would resolve. He pointed upward and said, 鈥淥nly Hashem knows.鈥� A deeply religious man, he wasn鈥檛 afraid to acknowledge the body鈥檚 mysteries or the limits of medical knowledge.
鈥淕ive it a few days and see if you get better,鈥� he frequently advised me. 鈥淐all if you get worse.鈥�
At each visit, my doctor would open a large folder and scribble notes by hand. My file is more than 4 inches thick. He never signed up for electronic medical records. He鈥檚 not monetizing his practice by selling it. For him, medicine was never about money.
鈥淒o you know the profit margins this hospital makes?鈥� he asked at our last visit, knowing my interest in health care policy and finance. 鈥淎nd how do you think they do it? They cut costs wherever they can and keep the nursing staff as small as possible.鈥�
Before a physical exam, he鈥檇 tell a joke 鈥� a way to defuse tension and connect with a smile. 鈥淒o you know the one about 鈥︹�� he鈥檇 begin before placing his fingers on my throat (where the thyroid gland is located) and squeezing hard.
Which isn鈥檛 to say that my doctor was easygoing. He wasn鈥檛. Once, he insisted I go to the emergency room after I returned from a long trip to South Asia with a very sore leg and strange pulsing sensations in my chest. An ultrasound was done and a blood clot discovered.
The young doctors in the ER wanted to give me intravenous blood thinner and send me home with a prescription. My doctor would have nothing of it. I was to stay in the hospital overnight and be monitored every few hours, efficiency and financial considerations be damned. He was formidable and intransigent, and the younger physicians backed down.
At that last meeting, my doctor scribbled the names of two physicians on a small sheet of paper before we said our goodbyes. Both would take good care of me, he said. When I called, neither was accepting new patients. Often, I hear this from older friends: They can鈥檛 find physician practices that are taking new patients.
Price, who鈥檚 68, went through this when his family physician announced she was retiring and met with him in January to work out who might take over his care. Price was admitted into the practice of a younger physician with a good reputation only because he asked a medical colleague to intervene on his behalf. Even then, the first available appointment was in June.
Orlowski had a similar experience two years ago when searching for a new primary care doctor for her elderly parents. 鈥淢ost of the practices I contacted weren鈥檛 accepting new patients,鈥� she told me. It took six months to find a physician willing to see her parents 鈥� again, with the help of medical colleagues.
I鈥檓 lucky. A friend of mine has a physician daughter, part of an all-women medical practice at a nearby university hospital. One of her colleagues had openings and I got on her schedule in December. My friend鈥檚 daughter recommends her highly.
Still, it will mean starting over, with all the dislocation that entails. And these transitions are hard, for patients and doctors alike.
Several weeks ago, I received a letter from my doctor, likely his last communication, which I read with a lump in my throat.
鈥淭o my beloved patients,鈥� he wrote. 鈥淚 feel so grateful for the opportunity to treat you and develop relationships with you and your families that I will always treasure. 鈥� I bid you all adieu. I hope and pray for your good health. I will miss each and every one of you and express to you my appreciation for so many wonderful years of doing what I love, caring for and helping people.鈥�
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