Causes of the shortage
- The numbers of medical students choosing primary care have decreased by half since 1997.
- Half of the primary-care physicians have stopped taking new patients, and the other half are more overworked and more stressed.
- The average income of primary-care physicians is in the mid $100,000s, less than half the salary of specialists, such as dermatologists or radiologists.
- Physicians have an average medical school debt of $200,000 and are looking to earn higher salaries.
- A lack of residency slots. There is no provision in the new health care law to increase funds for the purpose of increasing residency positions.
More work, less satisfaction and lower incomes
Since there is a shortage of primary-care physicians, those that are practicing have shortened their office visits in order to see more patients. Primary-care physicians are overbooked and have less time to spend chatting with patients. Ironically, this physician-patient interaction is a feature that initially attracted many physicians to primary-care practice. In addition to being one of the lower paying medical practices, primary care can also be considered a less satisfying career option.
Attracting aspiring physicians to primary care
Tufts University School of Medicine offers a $25,000 scholarship to medical students who commit to work in primary-care practices in rural areas during their training period. This year, 257 students applied for 36 positions. The drawback of this idea is that there is no way to enforce whether students actually enter primary care after graduating from medical school.
Other U.S. programs offer similar incentives. In addition, the National Health Service Corp (NHSC) gives scholarships and stipends in exchange for service in rural areas. The NHSC also pays back student loans.
Harris Berman, interim dean at Tufts Medical School, believes the primary-care physician shortage to be so severe that, "we need more than half the doctors in this country doing primary care."
Other alternatives to primary-care physicians
- 3-year medical degrees
- This would cut loans by $35,000-$50,000
- Started at Lake Erie College of Osteopathic Medicine in New York
- Canadian programs are in place at the University of Calgary and McMaster University in Ontario
- Texas Tech University offers a 3-year degree program only for students committing to primary-care practice. A 1-year scholarship is added, to essentially decrease the cost of medical school by half.
- Teamwork-oriented organizations, such as the Lahey Clinic, which is an "integrated group practice." In these systems, a "team captain" physician supervises nurses, PAs and other health care professionals, who check blood pressure and perform other procedures, short of diagnosing medical conditions. Money is also an issue with this approach, because nurses and PAs can make higher salaries at specialty practices. Another issue is that there is concurrently a growing nursing shortage; it is ineffective to "rob Peter to pay Paul."
- Foreign medical graduates can be recruited to work as primary-care practitioners; however, over 25% of primary-care practitioners are presently foreign graduates.
JAMA has estimated the need for an additional 45,000 primary-care physicians by 2020, just to keep up with the demand, and this estimation was made prior to the recently legislated health care reform. Even with medical schools expanding their programs, there will not be enough physicians to cover the amount expected to retire in the next decade.
Advanced practice nurses, nurse practitioners, and PAs have graduate training, allowing them to deliver primary care without direct supervision from a physician. In many states, this includes prescription privileges. This is another alternative.
To attract bright young physicians to primary care, a salary increase is key. In order to fund such a raise, Congress would need to increase health care funding, and the controversy continues.
