Whatever Happened to the Family Doctor?

On his walk to his clinic one winter day, a car came squealing to Dr. Tim Rumsey’s side. Behind the wheel was a frantic husband, and riding shotgun was his wife, her hand wrapped in a tea towel, the tip of one finger sealed in a plastic sandwich bag. Quickly sizing up the situation, Rumsey packed a little more snow around the severed digit, and calmly urged them to continue on their way to the emergency room at United Hospital in St. Paul.

“They weren’t actually patients of mine,” says Rumsey. “But I guess they’d seen me around enough in the neighborhood to know
I was a guy they could ask.”

In his years of walking to work through West Seventh Street, a hardworking neighborhood in the shadow of St. Paul’s old Schmidt Brewery, Rumsey has grown accustomed to such unscheduled requests for his opinion. He’s had patients leave their beers at the bar to lift their shirts on the sidewalk and show him the funny-shaped mole or the bruised rib. Others have offered him rides to his office at United Family Practice Health Center, opening their mouths on the way to say “aahhh” or asking his opinion on a lingering cough. The clinic he started three decades ago to reach the uninsured and underserved has merged and grown into a federally qualified health care center, chalking up 45,000 patient visits each year. The place is such a fixture in this corner of St. Paul that many people refer to the place simply as “Rumsey’s,” like the legendary steak house “Mancini’s,” the next parking lot over.

While he is not reimbursed for the time he spends talking to his patients outside of the office or even for the occasional house call he is still known to make to his oldest and most faithful clientele, he doesn’t list these moments as the downside of being a family doctor. In fact, he mentions them as the best part of his life’s work.

“It’s quite a beautiful thing to be taken into people’s lives like that, to hear their stories, and to feel that they trust you to know them,” says Rumsey. “It’s a great privilege to care for people like this. It’s still the best job there is.”

If Rumsey sounds like he’s trying to recruit more people into his line of work, that’s because he is. Across the country, the shortage of primary care doctors is so acute that now one in five Americans is considered “medically disenfranchised.” Even though a growing number of health advocacy groups are pushing the value of the so-called “medical home,” a shrinking number of physicians who can coordinate that care means that 56 million Americans are medically homeless—even though a majority of them have health insurance.

In Minnesota, 18 percent of adults don’t have a primary health care provider. That’s better than in Texas, where 60 percent of adults don’t have one, or in Massachusetts, which recently discovered it didn’t have enough family doctors to get a new universal health care plan fully implemented. Even so, Minnesota’s long-term prognosis isn’t great. Between 2000 and 2004, the supply of physicians going into specialties in Minnesota rose by 129 percent, while the number of primary care physicians—family medicine doctors, pediatricians, and internists—rose by only 20 percent. Nationwide, medical schools have seen a 50 percent drop in the number of graduates pursuing family medicine, and applications to family medicine residency programs have declined for several years running. Though the number of primary care residency slots has dropped in the Twin Cities, there still aren’t enough Minnesota graduates to fill them. Two-thirds of primary care residents in the Twin Cities now come from other states and countries, and they are far less likely to stay here to set up permanent practices.

The trend is so troubling that last spring the boards of Allina Hospitals and Clinics and the University of St. Thomas came together to consider the unusual possibility of creating a new medical school, with the goal of graduating forty new family medicine–focused medical students each year. The feasibility study suggested that the costs of building and staffing a third medical school in the state would be prohibitive (one estimate put the cost at around $40 million a year), and the boards of both institutions voted against proceeding. Even so, observers say that the tabled proposal doesn’t end the debate about how to save the family doctor—instead, it’s only the beginning.