Millennial Natasha Nuñez doesn’t have a primary care physician and doesn’t plan to.
At one point, the 33-year-old yoga teacher and blogger reached out to the one practice in town that accepts her insurance. “I filled out an application to be a patient with them, and they’ve never gotten back to me,” she says.
She stopped trying. At this point in her life, she doesn’t see the benefits of a traditional primary care doctor. It’s more hassle than it’s worth.
Her sentiment mirrors that of other millennials. A 2019 survey of 2,000 adults between the ages of 23 and 38 found that 24 percent of millennials don’t have a primary care doctor and an equal number have not had a physical exam in more than five years.
A Kaiser Family Foundation study presented even more startling findings: as many as 45 percent of adults between the ages of 18 to 29 don’t have a primary care doctor. In other words, the next generation is unlikely to pick up the slack.
There’s no shortage of commentary on how millennials are changing the healthcare landscape. But most talk about millennials, not with them — echoing the paternalism that this generation often feels from doctors.
We reached out to a few dozen young adults for their take on healthcare, what they’re looking for in a doctor, and how health systems can adapt to meet their needs.
Value my time
Now solidly in their 20s and 30s, millennials have careers and families. Their lives are busy and they often feel like doctors don’t respect their time.
Kyle Cade Russell*, 24, says he has to wait on hold for 10 minutes to get a hold of his primary care doctor, who is frequently booked six weeks out. That works for annual exams, Russell says, but it isn’t helpful when he’s actually sick and needs medicine, at which point he resorts to an urgent care.
As of 2017, the wait time to schedule an appointment had soared to 24 days in major cities and will likely continue to climb as more medical students, many of whom are young millennials themselves, choose to specialize instead of going into primary care.
Patients feel the physician shortage both before appointments and in the actual waiting room.
Nuñez cited the time commitment of seeing a doctor as one of her chief reasons for forgoing a primary care relationship. The young mom says every time she had scheduled a routine appointment for her or her daughter, it took several hours to be seen.
“That time is simply spent waiting, even at early morning appointments,” she says.
Russel says when he does get an appointment, it’s too short to be meaningful. “Since the schedules are packed, I rarely get more than 15 minutes in the exam room with my doctor, which isn’t enough to ask any questions about how I’m taking care of myself,” he says.
Engineer Dina Twila Bellamy*, 34, agrees. She moved from a small town to a large urban area in southern California and now bounces from doctor to doctor trying to find one that’s worth sticking with.
“I see my doctor for like five minutes, if that, and they’re always in a rush and just gloss over things to get me out,” she says. “I feel like the quality of my care is pretty bad, and therefore I am not particularly proactive with it.”
Value my insights
While they’re not seeing primary care doctors as much as previous generations, millennials care deeply about their health. And they’re both tech savvy and health literate enough to conduct their own research — including sifting through medical journals.
“I wish doctors understood that I’m going to do my own research, and I’m going to challenge what they say,” says Jordan Bishop, 27, founder of How I Travel. “I’m going to read peer-reviewed journals, I’m going to cross-reference what they say, and if they suggest a treatment that I don’t feel is best, I’m going to raise that with them.”
He says that while he recognizes that his provider is the doctor, “no doctor knows everything, so I want to be a part of the process, too.”
Engage with me
Health systems long for this level of patient engagement, but understandably, not every provider appreciates their medical opinions being challenged.
Artem Cheprasov, health writer at Healthonym says the solution for this is found in physicians first understanding that millennials do more than cursory research on their health.
“When they enter the clinic, they are ready to discuss things with their doctor in depth,” Cheprasov says. “But, for a multitude of reasons, they are often rushed out the door or their comments are dismissed. This doesn’t foster a healthy relationship.”
He says physicians should try to engage on a deeper level — even when it means contradicting what a patient thinks. This isn’t dismissive, it’s engaging.
“Being wrong may make someone feel temporarily stupid, but having been enlightened thereafter, quite empowered,” he says. “This is much better than the alternative: being ignored and left feeling like your thoughts and efforts in your own health don’t even matter.”
“Technology is the key for reaching millennials,” says Bishop. He doesn’t expect providers to be on the cutting edge, but appreciates little things, like automated appointment reminders and a mobile-friendly website.
“If the best doctor in the world has a bad website, I’m not going to become a patient — period. Your website is the first point of interaction with many patients, and those first impressions go a long way,” he says.
Jess Johnson, 34, one of the few millennials surveyed who sees her primary care doctor regularly, appreciates her provider’s forward-thinking approach to technology. She enrolled in its patient portal and values being able to schedule online rather than having to pick up the phone and call someone.
Just text me, already
Do a Google image search for millennials, and the top results are of young adults with phones or tablets in their hands. It’s not just a stereotype — 92 percent of millennials own a smartphone and they’re on it for at least five hours a day. If you want to reach them, text them.
“I coordinate everything through text message — veterinary appointments, hair care, Amazon deliveries, even getting my car serviced — why can’t I text the doctor?” says Satva Puranam* 32. “Just let me know you’re running behind schedule so I don’t have to take three and a half hours for a 20-minute appointment.”
It’s not just routine contact and automated messages they want, either. Liz Jeneault, 28, fitness influencer and VP of marketing at Faveable, sees technology as an opportunity to be more personal with patients.
“As a new mom, I would have liked for my OBGYN to send me a couple of texts or to follow up with me in the weeks after giving birth,” she says. “I think it’d be nice if doctors would be more personal with their patients and do things like that! I think it makes you feel taken care of, like they are looking out for you.”
Regular check-ins with a doctor via text might also help encourage people to think about and better address anything that might be ailing them, she says.
Likewise, Nuñez says she would love to see a greater integration between doctor’s offices and technology. Her OB uses a secure online messaging system, which she appreciates. And the concierge medical service she is considering allows patients to send information from wearables or medical devices directly to the provider.
“I think patients and doctors would benefit from this in more traditional doctors office settings, too,” she says.
Tell me what this is going to cost
For a generation adept at comparison shopping and sending and receiving money with their mobile phones, purchasing anything without knowing the cost is unfathomable. Waiting for weeks to get a bill in the mail, unacceptable.
“When I get the bill for a 20-minute appointment, I’m always asking what I’m even paying for,” Puranam says.
Similarly, Jeneault says she is proactive and always checks to ensure a doctor is within her network. She also considers what they might charge for services, but says she still prepares for surprises. When her daughter was a newborn, she had a high fever and they visited a small, local emergency room. Doctors offered no treatment. Still, the family received a $1,000 bill.
Jeneault called the hospital to complain. “It ended up working out in the long run because I was sure to explain that I would leave a lengthy review detailing the ridiculous charges for zero service, if they didn’t reduce the bill,” she says. “I suggest people always look at their medical bills in full detail and call if you feel you’re being unfairly charged!”
Not only do millennials want price transparency, they take their views online when they receive inaccurate or excessive medical bills.
Convince me it matters
While millennials care deeply about their health and value prevention, they don’t necessarily see regular visits to a primary care physician as the best way to achieve it.
That’s not necessarily a bad thing, especially considering the growing doctor shortage.
Preventative measures still matter, of course. But, delivering them efficiently outside of the traditional primary care model may prove more effective for both health systems and the growing demographic that makes up both their workforce and their patients. ♥
*names changed where noted to protect patient identities
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Pamela Ellgen is WELL’s Health Editor. She began her career in community journalism and is the author of more than a dozen published books. She is a graduate of Washington State University.