Americans today are facing a severe shortage of primary care specialists. A 2009 study in the Journal of the American Medical Association (JAMA) states that only 2 percent of the graduating classes of medical schools today are entering residency training in primary care.
A 2009 study shows that only 2 percent of the graduating classes of medical schools today are entering residency training in primary care. Many are going for more lucrative specialties.
Primary care is defined as the practice of Internal Medicine (the care of adults), Pediatrics (the care of infants and children), Family Practice (the care of all ages), or Internal Medicine/Pediatrics combined (also the care of all ages). Although OB/GYNs are sometimes thought of as primary caregivers for the female population, the previously mentioned specialties are quoted in the JAMA article.
It is estimated that there are currently 56 million individuals in this country that are “medically disenfranchised”— having inadequate access to primary care physicians (PCPs).
Among Medicare beneficiaries, 3 percent, or more than 1.3 million people, have difficulty finding a new primary care physician.
So, where have all the PCPs gone? There are many answers to this question. Many older physicians are dying and not replaced by new physicians. Many are “throwing in the towel” and retiring much earlier than originally planned. Some have left the stress and demands of private practice and teach full time.
Some new graduate physicians are choosing a new specialty called “Hospitalists.” These are PCPs who only care for hospitalized patients. They do not have private practices, alleviating many of the pressures physicians so often feel.
There is more and more bureaucratic red tape from insurance carriers, more stumbling blocks to get tests ordered, approved and performed. Decreased reimbursement from the carriers and increased malpractice premiums are also a few reasons.
Because Medicare and insurers fix fees, the only way PCPs can survive is to take on more and more patients. This, in turn, may mean spending less time with each patient. As a result, we often hear patients complain: “My doctor doesn’t spend enough time with me.”
A 2009 study by the American College of Physicians (ACP) compared the U.S. health system with those of 12 other countries and analyzed why the others had better medical outcomes with far less funding. Over and over the studies prove systems that have a PCP or what is deemed “medical home,” always fare better.
The overhead in a PCP office runs about 65 percent, of which 40 percent is spent dealing with insurance companies. Another reason is that the earnings of PCPs are about half to a third of our colleagues in the more lucrative sub-specialties.
This correlates with the matching of residency spots this past year. Only about 42 percent of primary care spots were filled, while in orthopedic surgery, 94 percent were filled. It goes without saying that graduating medical students who often have at least $150,000 in debt, will choose the more lucrative specialties.
There is a new trend evolving in many parts of the country called “Concierge Medicine.” Although not always looked upon favorably, it’s another option for PCPs to remain in practice, and allows patients to continue receiving the quality care they deserve.
With concierge medicine, the patient pays the PCP a fixed amount of money, either monthly or yearly and is given “customized care.” This means they often get the physician’s home phone number, cell phone number and appointments that usually last upwards of one hour. This happens almost always on the same day the call is placed. The physician can then focus on “the patient” and not on survival.
Too much of the physician’s time is spent taking care of the insurance carrier’s work. Study after study has shown that patients who have a PCP often are healthier, and when an illness occurs, it is usually diagnosed at a much earlier stage.
Unfortunately most medical schools in this country favor over-specialization. Many of the “osteopathic” medical schools (schools granting Doctor of Osteopathic Medicine degrees versus Allopathic that grants Medical Doctor degrees), highly promote the training of primary care physicians.
I am happy to say that there are many efforts to entice medical students to enter primary care on the horizon. Some include loan forgiveness and financial incentives to help get started in practice.
I only hope this occurs sooner than later.
This column is provided by the Richmond County Medical Society. The author, Dr. Ralph Messo, is a past president of the Society. He maintains a private practice in Eltingville and is director of Medical Education at Staten Island University Hospital and adjunct clinical professor at Touro College of Osteopathic Medicine.