The family doctor is out

Also: Tensions boil over for Canada and India.   Tuesday, September 19, 2023: Hey readers, How’s it going? It’s [Izzie Ramirez]( here with what you need to know today: Up first: The decline of primary care providers. In other news: Canada’s allegations against India, Biden’s speech at the United Nations, and the overdose death of a 1-year-old.   UP FIRST What happened to the family doctor? Min Heo for Vox When was the last time you saw your primary care provider? If it’s been a while, you’re not alone: Longstanding patient-doctor relationships, once the foundation of medical treatment, are becoming less common. The number of Americans who say their source of medical care is a personal physician [has been steadily declining](. The lowdown: Primary care doctors are intended to be patients’ first contact point with the health care system. These are the docs you would see for physicals, basic medical tests, and treatment for mild illnesses. - As of 2018, [nearly half]( of adults under 30 said they did not have a primary care doctor. - Many opt instead for the convenience offered by urgent care clinics, clinics in retail stores, and even their local emergency room. - The field is becoming less attractive to aspiring doctors, who can [make more money in another specialty](. - Compounding the problem: For the first time, fewer than half of doctors own their own practices. Doctors younger than 40 are [much more likely]( to work for somebody else than their older counterparts. The stakes: To be clear, a lack of primary care doctors isn’t the fault of everyday Americans. By [one recent estimate](, 100 million Americans face some kind of barrier (physical or financial) to accessing primary care. One in five Americans [doesn’t have a regular source of health care](, a share that has been steadily growing since 2000. When patients have a steady primary care relationship, they tend to be [healthier and live longer](. Research has consistently found that a long-term relationship with a doctor leads to better health results. When patients lose their longtime primary care doctor, the number of emergency department visits and hospital admissions increases, as does their [mortality rate](. [Read health care reporter Dylan Scott’s full explainer on all the ways steady primary care is faltering here](.   HEY READERS! This month, we're aiming to add 2,500 financial contributions from readers to help keep Vox's unique explanatory journalism free for everyone. Will you join us? [Yes, I'll give to help keep Vox free](   NEXT UP Canada and India’s feud, briefly explained Dave Chan/Getty Images Relations between the two countries soured over new accusations from Canadian Prime Minister Justin Trudeau. Here’s what you need to know: - Trudeau claims that “agents from the government of India” assassinated a Sikh community leader in British Columbia in June. The Canadian Prime Minister’s allegations were based on national intelligence, he said. [New York Times]( - The community leader, Hardeep Singh Nijjar, had advocated for an independent Sikh nation separate from India. Indian authorities had designated him as a “terrorist” for association with the Khalistan movement, which calls for a Sikh nation and which is illegal there. [Guardian]( - Now, a tit-for-tat expulsion of diplomats is underway. Canada expelled an Indian diplomat, and India followed suit. [CNN]( PRESS PLAY Join Unexplainable in NYC! Vox’s award-winning science podcast is hosting a live night of fun and learning with special guest comedian and writer Wyatt Cenac on Thursday, September 21. [Get your tickets now](   AROUND THE WEB - President Biden speaks at the United Nations General Assembly. He heavily emphasized cooperation and partnership with allies. [New York Times]( - A fentanyl package was found at a Bronx daycare center where a 1-year-old died. Three other children tested positive for the drug, which can kill adults even in small doses. It’s unclear how fentanyl wound up at the apartment daycare, but a kilo of the synthetic opioid was found in a nearby hallway. [Guardian]( - Why some galaxies are sparking controversies among scientists. The high-powered James Webb Space Telescope allows astronomers to study farther, earlier galaxies. Now, with new data in hand, scientists are questioning the age of the universe. [NPR]( - Proper hypertension treatment could prevent 76 million deaths globally by 2050, WHO says. High blood pressure affects one in three adults worldwide and can lead to other health problems such as heart attacks, stroke, and kidney damage. 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