One in five has no regular doctor

Here’s a disturbing stat: Some 60 million Americans – one in five – “have no usual source of medical care, such as a family doctor or clinic.” That’s according to a new statistical brief issued by the U.S. Agency for Healthcare Research and Quality.

Reasons varied. More than two-thirds of the African Americans who reported not having a family doctor or to regularly visit a clinic attributed this to a lack of need: They claimed to seldom or never be ill. Others who avoid the doctor have cited the high cost of health care, especially some 29 percent of those who lack insurance (compared to just four percent of people who are privately insured). At 22 percent, Hispanics were the largest ethnic group avoiding doctors and clinics. A few people just don’t trust doctors. Asians were most likely to give this reason – 12 percent versus 4 percent for all other Americans.

James Kirby of AHRQ detailed his findings in a December report for the agency. He synthesized data from a nationally representative survey in 2007 that was administered by his agency and the National Center for Health Statistics.

In general, low-income Americans were less likely to avail themselves of doctors and clinics on a regular basis. This doesn’t mean they won’t use emergency rooms when they do become sick. Indeed, other studies have shown that too many people use high-overhead hospital emergency services to handle routine medical needs – precisely because they don’t have a regular doctor.

Not seeing a physician for regular checkups and immunizations may account for why so many people walk around with symptomless illness, such as atherosclerosis and diabetes. Without early diagnosis and treatment, these silent disorders can worsen and lead to more costly and less effective therapy if and when symptoms do emerge.

A case in point: I know of a website developer in his 50s who last month learned that his growing vision problems were signs of irreversible diabetic retinopathy. The man had until then been unaware that he had diabetes. And he initially shied away from exploring the source of his developing blindness because, lacking insurance, he reasoned that he couldn’t afford to see a doctor. A friend ultimately found an ophthalmologist who agreed to see the patient pro bono. Unfortunately, it was too late to save the man’s vision.