You’re not alone if you’re feeling frustrated. Far too many have difficulty these days finding a primary care doctor who can be your “home base:” Someone to give you an annual check-up, be there for you when something seems wrong, guide you to specialists when you have particular problems, and just generally be by your side as your body ages and problems arise. It’s not your imagination that it’s hard to find a primary care physician these days (let alone a geriatrician). And if you do find one, the average wait time to get into a primary care office if you’re a new patient is at least 26 days. There are a number of forces in play creating a real shortage of primary care physicians in the US. In fact, there are fewer primary care physicians in the United States than almost all of our European counterparts. Why is that? More primary care physicians are leaving than are being replaced. Doctors are retiring and new doctors can obtain better pay by entering specialty fields. Large healthcare facilities, corporations, and private equity firms are buying up solo practices. There’s more demand for primary care doctors due to expanded insurance from the Affordable Care Act and an aging patient population. In fact, by 2034, there are predictions that we will have a shortage of up to 124,000 primary care and specialty physicians in this country. That’s a worrisome statistic, given that research shows that when patients have a steady primary care relationship they tend to be healthier and live longer.

What if you specifically want to find a geriatrician who truly understands the effects of aging on the body and what can be considered normal aging versus what symptoms are worrisome? That may be an even more elusive search. The data are startling: In 2000, there were 10,000 board-certified geriatricians for a 65 and older population of 35 million. Now, there are more than 55 million in that demographic, yet only 7400 board-certified geriatricians. Why are the number of available geriatricians dropping?  The reasons range from the low pay as compared to other “specialists” to the disinterest in having patients “who don’t get better,” to the relatively low status of geriatricians in the medical community. Even the wonderful geriatrician Dr. Leslie Kernisan from Better Health While Aging admits finding a geriatric primary care physician is a tough slog. Nonetheless, she does provide a few recommendations if you are on the hunt. Grab your pen and jot down her suggestions here.

So what alternatives exist? You may have heard of “concierge medicine,” a form of medical practice in which doctors see fewer patients, are more accessible, and may even get you into the office on the day you call. While the upside sounds great, the downside is the financial commitment of this higher-quality relationship with a physician. The cost of being a patient in a concierge practice can range anywhere from a couple of hundred to thousands of dollars a month. Some practices don’t accept any insurance (though you’ll need to keep your insurance for any services outside of the practice) and some do accept insurance after you pay the membership fee. The concept sounds like a throwback to simpler times when your physician may have spent quality time listening to your concerns, and the availability of just such a relationship is what drives many physicians into such practices. But unless you have an expansive budget, it’s probably not an option for most. Other alternatives? Everything from urgent care centers to “minute clinics” in pharmacies like CVS can handle urgent, non-life-threatening problems, but they don’t provide the sort of ongoing care and guidance of a long-standing relationship. There’s also telehealth, which many medical practices and healthcare systems are using as a way to handle excess demand in the midst of physician shortages. Some systems recommend you use a patient portal and message your physician if you have a question or need some guidance. But you need internet access and online confidence to use such a system and you should be aware that some practices are now charging for physician interactions online.

All of this underscores that when and if you do find a primary care physician and get an appointment, you need to be prepared and efficient with whatever face-to-face time you get. You may want to check out agebuzz contributing editor Julie Buyon’s posts about being an empowered patient in your relations with your physician. There are also a host of other resources that can guide you on how to get the most out of a visit, including preparing your questions in advance, worksheets to help guide the discussion, bringing along a trusted friend/family member to help you, and even recording the session (with permission) so you can be sure you heard everything. For some guidance on how to create a good partnership with your primary care physician, take out your notebook and get ready by clicking here, here, and here.