Dennis Thompson, Managing Editor, HealthDay.comWelcome to part 2 of our continuing series on the growing shortage of family physicians. Today, we're joined by Dr. Dale Block, a family medicine physician who spent more than four decades caring for patients and their families.Dr. Block retired in February 2025 after a distinguished career in primary care. Now, he reflects on the challenges facing family medicine today, why the physician shortage continues to worsen, and what it will take to preserve the profession he dedicated his life to.Dr. Block, thank you for your time. Thank you for being here.Dale Block, MD, MBA, Retired Family Physician, Strategic Healthcare LeaderHappy to be here, Dennis.Dennis Thompson, Managing Editor, HealthDay.comSo, you retired last year. what led to your decision to retire?Dale Block, MD, MBA, Retired Family Physician, Strategic Healthcare LeaderWell, I had spent a significant amount of time in clinical medicine till my back gave out.So, I practiced probably, you know, for the better part of three and a half decades. and from that I went into full-time administrative work, where I was the chief medical officer for a Medicaid health plan, third largest plan in the country, actually. And finished up my career at the Department of Medicaid in Ohio as one of their medical directors.Dennis Thompson, Managing Editor, HealthDay.comSo, over your span as a family physician, what are the major changes that you saw to the profession?Dale Block, MD, MBA, Retired Family Physician, Strategic Healthcare LeaderThat's a great question. You know, I'm of the generation that was trained in the cottage-like industry where primary care docs, family docs were maybe one, you know, solo practice or maybe two.And I think what happened is that there was a push to move as much as possible into value-based care, which started out as the HMO project, health maintenance organization. Docs didn't want to be in independent practice anymore. They didn't want to be businessmen. They simply wanted to see patients. And the result of that movement essentially took the autonomy away from physicians that became employed docs. And that hit the primary care docs, I think, much harder than specialty medicine.And because of that then you began to see, you know, other forms of managed care trying to lower the total cost yet provide the outcomes and high-quality care that was expected. And with that came a whole different business acumen from administrators who had never seen patients before but had expectations for the physicians. especially the primary care docs as to the volume that needed to go through the office in order to break even or actually make a profit while trying to maintain you know high quality standards…And then of course we watched the electronic health record come in, which really destroyed I think the doctor-patient relationship that had really been there for many, many years, especially on the primary care side.There was too much focus on the administrative side, the quality side, the productivity side of medicine... spending way too much time looking at the computer instead of actually being with your patient and helping them with their problems.Dennis Thompson, Managing Editor, HealthDay.comNot only looking at the computer, but then also I guess having to fill out forms after you've seen the patient and respond to patient questions through the portal and all that. Does that contribute to it as well? Dale Block, MD, MBA, Retired Family Physician, Strategic Healthcare LeaderYeah, I think you know, Dennis, that that contributed to it. but I think again, it just depended on the physician.I stayed every night to make sure that my work was done so that I was fresh, ready to go in the morning. I never brought work home or charting home so that when I got home, yeah, could be home. And I think that's the other thing that I saw, certainly the generation of you know my son now who's been out of residency for several years bringing his work home, sitting and doing charts at night, getting charts ready in the morning before going to the office. Dennis Thompson, Managing Editor, HealthDay.comI do know that younger doctors, you know, of your son's generation are retiring earlier. They're either leaving medicine or they're moving to another specialty at an earlier age than your generation.Dale Block, MD, MBA, Retired Family Physician, Strategic Healthcare LeaderI'll use my son as an example. He started his own practice with another young physician that I mentored as well. And he just found that it was just you know too much. the demands were greater and greater. The amount of reimbursement based on the amount of time put into practicing was just not what it needed to be as kind of inflation goes and generations move along. So now he is, he's in Colorado starting his own concierge practice that's been up and running now for two years, which is a membership like concept. But he's running his own practice again.And he's doing, you know, more preventive care, more health promotion, health protection than was really allotted when you were in that widget mode, you know, running room to room, managing acute and chronic care and trying to get everything else in for the patient in order to, you know, keep them moving in a healthy state.Dennis Thompson, Managing Editor, HealthDay.comBased on your career and your knowledge, is primary care, is family medicine essential for people to get the care that they need?Dale Block, MD, MBA, Retired Family Physician, Strategic Healthcare LeaderPrimary care remains the cornerstone of any high performing healthcare delivery system, regardless of where it is in the world.Primary care manages close to 40% of all patient care, but yet they're probably at 5, maybe 10% in some good states, 10% of the total health expenditure. And that hasn't changed much. And I think the only way that will change in order to get more medical students into primary care so that they'll stay in primary care-- we'll have to legislate and regulate that spend on a state by state basis, that the health plans are going to have to ante up and make sure that we move in that direction or we will not have enough primary care docs.Dennis Thompson, Managing Editor, HealthDay.comSir, this has been great. Thank you so much. I mean, this has been a wonderful interview.Dale Block, MD, MBA, Retired Family Physician, Strategic Healthcare LeaderYou're welcome. .Sign up for our weekly HealthDay newsletter