Do you feel like a doctor’s visit these days is sometimes akin to being herded like cattle? My mother related to me that her recent visit with her doctor lasted “five minutes.” She may not have been exaggerating. A few minutes is hardly enough time for a physician to thoroughly examine anyone. So some patients are turning to what’s called “concierge care” – paying a doctor an extra annual fee for the privilege of more time and attention. Critics of concierge care worry that if it becomes widespread, it could make access to care more difficult for those who can’t pay extra. But the doctors who provide the service say it’s a way to relieve the burden of seeing so many patients during the day, gives them the opportunity to do a more thorough job for their patients, and helps keep them from losing money in an environment of high costs and low reimbursement rates.

Meanwhile, a shortage of primary care physicians, combined with the expected influx of 30 million people soon to be added to the insurance rolls via the Affordable Care Act, is contributing to the rise of retail medical clinics. Retailers such as CVS Pharmacy and Target are building in-store clinics which employ nurse practitioners or physician assistants to provide simple check-ups and treatments for minor conditions. Critics contend that these retail clinics are inadequate for managing more complex conditions. But the harder it is for people to get a doctor’s appointment, the more people turn to these clinics.

Both “concierge” care and retail health clinics are symptoms of a dysfunctional American health care system where the quality of care is still determined by how much someone can pay. So we are hurtling toward a two-tiered healthcare system, one where the well-to-do can pay extra for more attention and another where people who can’t get a doctor’s appointment at all must turn to the limited offerings of a retail clinic.

These trends show how the United States hasn’t kept up with the rest of the industrialized world with universal healthcare systems in producing enough primary care physicians for its population. According to the Organization for Economic Co-operation and Development, the U.S. has 2.4 physicians per 1,000 people compared with an average of 3.1 per 1,000 for all OECD nations. No wonder those doctors turning to concierge care feel rushed. And no wonder corporations see an opportunity to fill a void.

Medical school tuition in America is way too expensive, forcing many young physicians to eschew primary medicine (or practice in rural and low-income urban areas) in favor of entering the more lucrative specialties. By 2015, the U.S. will be nearly 63,000 doctors short of what’s needed for the population.

“We have a shortage of every kind of doctor, except for plastic surgeons and dermatologists,” said Dr. G. Richard Olds, the dean of the new medical school at the University of California, Riverside, founded in part to address the region’s doctor shortage. “We’ll have a 5,000-physician shortage in 10 years, no matter what anybody does.”

The American Medical Association in the past worked to keep a lid on the number of new doctors because the organization feared a physician glut. So the construction of new medical schools slowed. The AMA’s error in judgment has proven costly for our healthcare system. Another contributor to the physician shortage has been federal spending cuts to training programs for medical graduates. Add to all this an aging baby boom population, an exodus of retiring physicians and a lot of unhappiness within the medical profession itself.

We now have another mess, on top of out-of-control costs and unequal access. Even with the Affordable Care Act in place, many may still not get the care they need, unless they can pay extra. Under the ACA, the Obama administration has pledged to provide funding to train more primary physicians to practice in underserved areas. Yet, more must be done. The cost of medical school – like the cost of college – must come down dramatically. Without the burden of crushing loans, more newly minted doctors can go into primary care. Taking the profit out of health care by establishing a truly universal, publicly-supported system would also help bring bloated specialist salaries back down to earth. If the U.S. had in an earlier time treated health care as an equally shared public good, rather than a commodity, the very idea of having concierge care and corporate health clinics would sound like a bad joke.