By Karen Finucan Clarkson

There are few relationships that are more important than the one you have with your doctor. There's a possibility it might one day save your life.

While they go by different names—family/general practitioner or internist—these primary care physicians not only provide basic medical care, but may also coordinate and manage other care you receive. "The most important thing is to find someone who will spend time with you," said Dr. Shishir Khetan, an internist with Premier Physician Group/Rockville Internal Medicine Group in Rockville. "You need someone who will listen, who will return phone calls and who, if something urgent comes up, will be there for you."

That was important to Dorothy Murdoch when she went looking for a doctor. "When I interact with a doctor, I need to feel as though I'm the only person on the planet," said the Bethesda resident.

But time, these days, is at a premium. "As [insurance] reimbursements for primary care shrink, so does the amount of primary care time," said Khetan. With primary care physicians seeing anywhere from 25 to 35 patients a day, due both to the many people needing care and to having to cover the cost of doing business, the amount of time doctors can devote to each patient is often limited.

One issue with finding a primary care physician is that many aren't taking new patients. "It was frustrating," said Murdoch. "I'd get names from friends, compare them to the Washingtonian list and my insurance company, then call the office and find out they're no longer accepting patients."

Jared Hosid's experience was similar. After calling the offices of every physician that appeared on both the Washingtonian and Consumers' CHECKBOOK Web sites, he still didn't have a doctor. "None of them were accepting new patients," said the Bethesda resident.

That problem is expected to worsen as the number of U.S. medical school graduates entering the primary care field continues to drop – in the case of family practice by as much as 50 percent, according to testimony Jeanne M. Lambrew, Ph.D., gave to the House Committee on Appropriations, Subcommittee on Labor, Health and Human Services, and Related Issues. Facing enormous debt from their medical education, 98 percent of med-school students say they plan to choose higher-paying medical specialties, according to a report by Dr. Karen E. Hauer in the Sept. 10, 2009 issue of The Journal of the American Medical Association.

The smaller pool of doctors has made it more difficult to get appointments, as the average primary care physician in Maryland has upward of 2,500 patients, says a report by the Maryland Insurance Administration.

Dr. Mark Seigel, a Rockville obstetrician/gynecologist, said his wife left her internist when she was sick with pneumonia. "The office told me they didn't take same-day appointments and she'd just have to go to the emergency room," he said.

Those who require same-day access might consider a physician in a retainer practice. "You pay in advance in order to have immediate appointments and access to the doctor's cell phone," said Khetan, who sees an "ethical dilemma" that prevents him from participating in what is also called boutique or concierge medicine. Retainer practices generally serve no more than 600 patients, require an annual fee—most exceeding $1,500—and do not accept insurance. Many retainer physicians make house calls.

An issue with such practices, according to Khetan, is that "not everyone can afford the retainer fee, particularly with the current economy." In Khetan's opinion, retainer practices, because they carry a reduced patient load when compared with standard practices, also contribute to the log-jam in other physician offices. "A retainer physician may carry a total patient load of 200-300 patients compared to at least 2,000 in a traditional practice. If all primary care doctors limit their number of patients, there will be an even greater shortage of primary care doctors."

With the plight of primary care now on the front burner—both Congress and the Obama administration held hearings and meetings in March—many believe changes are in the offing. What form those changes take and how long it will take before primary care physicians and their patients see results remain undecided.