According to a recent Kaiser Family Foundation (KFF) poll, shockingly large swaths of Americans have reported that they don’t have a primary care provider.
The July 2018 report found that 45 percent of 18-29 year olds, as well as 28 and 18 percent of 30-49 and 50-64 year olds, respectively, also lack designated primary care.
Kaiser Health News (KHN) explained that the price transparency, convenience, and speed of alternatives to office-based primary care physician (PCP) visits appear to be some of the preferences driving these patterns. Retail clinics, urgent care centers, and telemedicine websites satisfy many of these preferences, and are therefore appealing alternatives to scheduled appointments with a PCP. For example, extended hours and shorter wait times at increasingly widespread retail clinics have attracted young patients who want to avoid the hassle and wait times involved in scheduling and attending a traditional doctors office.
A 2015 PNC Healthcare survey similarly found that millennials saw their PCP significantly less (61 percent) than baby boomers and seniors (80 and 85 percent, respectively). The study emphasized the effects of technology on millennials’ trends in healthcare acquisition, such as higher utilization of online reviews to shop for doctors (such as Yelp). It also found that millennials are much more likely to prefer retail and acute care clinics, and are more likely to postpone treatment due to high costs than older generations.
Use of online searches may provide instantaneous explanations about symptoms, but it has also caused concern about millennials’ ability to distinguish between high- and low-quality resources and to know when in-person visits are necessary. And research has indicated that care alternatives are actually increasing healthcare spending, as patients increasingly get routine care at retail clinics that they wouldn’t have obtained if they had to go through the hoops of scheduling a traditional appointment.
According to a recent JAMA Internal Medicine report, many more patients were receiving unnecessary or possibly harmful antibiotics prescriptions if they visited an urgent care clinic for ailments like the flu than those who visited doctors offices.
KHN discussed how annual physicals are no longer recommended, with guidance now advising patients to tailor their general health check regularity based on their age and risk. If regularly scheduled PCP appointments are no longer advertised as necessary, this could contribute to millennials choosing to visit an urgent care clinic when they do have symptoms, where they can be seen quickly, rather than unnecessarily engaging routinely with a PCP. However, I’m not aware of evidence that millennials have interpreted this advisory change differently than older patients that would explain the disparities in healthcare alternative utilization.
Different needs could also partially explain the difference in PCP uptake between age groups, such as having a PCP aware of your medical history might be more appealing to older patients. Moving patterns could also factor into decisions of whether to take the effort to build a relationship with a PCP, where it might not seem necessary if you’ll only be in a given location for a short period of time.
A 2015 Census Bureau report found that young adults had the highest migration rate as compared to other age groups. However, other research has found that “mobility among millennials is at an all-time low,” (although this research also found that mobility rates have declined proportionately across age groups over the last decades).
In a recent Letters to the Editor column, KHN shared some responses to its article on the July KFF poll results. A family medicine doctor discussed the importance of developing technology to meet the preferences of millennials, such as acting on the ability to provide portable health records or a shared information hub that would enable access to a patient’s health information anywhere.
However, another recent KHN article described the challenges patients face in obtaining their health records, despite federal protections of their right to receive this information upon request. I could imagine this becoming even more problematic in the face of decreasing interactions with PCPs, given that medical records may be dispersed across several walk-in clinics.
The KHN article discussing the July poll did receive some pushback. The Letters to the Editor column shared critiques that the article concluded too much about the current millennial population. For example, the family medicine doctor discussed above stated that the “thesis is inadequate without a historical comparison to how young people accessed health care five, 10 or 20 years ago.” He also stated that based on experience, “healthy young people use medicine services only for urgent care and pregnancy until they develop chronic conditions,” a sentiment echoed in another response that “[i]t’s not so much the new generation as it is the age group.”
And while the tendency to receive medical care from PCPs may be particularly high among millennials, it’s recognized that across generations, expectations have changed towards more convenience. The role of technology, such as making medical records accessible, and monitoring the accuracy of online resources, will be extremely important in ensuring quality care is maintained in the face of these trends.