Primary Care Shortage in U.S.
August 9th, 2012The New York Times published an article titled “Doctor Shortage Likely to Worsen With Health Law“. In this shocking article, they stated that by 2015 there will be a shortage of almost 63,000 primary care physicians. Part of this will likely come from the expanded access to health care, but that still only accounts for some of the number. We are already seeing a long wait time to see physicians in many parts of the US.
I think there are many reasons for this growing problem. First, to become a physician in this day and age requires a large capital and time investment. The average cost of medical school after obtaining an undergraduate degree is about $200k. On top of that, residency can be as short as 3 years or as long as 9 years. During this time a resident may make barely enough to live, and won’t be able to put even a small dent in his/her growing debt. Other fields such as finance and law require much less training and hence are luring much of our talented youth away from healthcare.
In my medical school class, I recall students would boast about wanting to go into specialties such as orthopedics and dermatology. These were the considered the “top” fields as they considered the highly compensated lifestyles more desirable. It is sad to say that as a result of rewarding specialties with increased compensation, the healthcare system has shifted even more students away from primary care.
This trend continued on during my internal medicine residency. Internal medicine is a gateway to a whole other host of specialties including gastroenterology and cardiology. Again, it was considered de rigueur for everyone to apply to a specialy. Over half of my residency class ended up in a fellowship for one of these. A minority ended up practicing primary care like myself. Sadly, many primary care practices are having to turn people away as they have reached maximum capacity. It is not uncommon these days for doctors to say they won’t take certain types of insurance (generally the ones that don’t pay sufficiently), or that they are not taking new patients. Others have decided to retire early, citing the uncertainties of the future of healthcare and the complexities of billing and receiving adequate compensation for their time. Running a private office comes with huge pressures to generate money to pay for overhead costs such as equipment, rent, skilled healthcare providers, and secure electronic medical record keeping.
What can be done to prevent the shortage? I think the government should help out those that are interested in primary care from the beginning. Perhaps offering financial assistance to those students who will be making a commitment to serving as a general practioner would be a good start. Many countries in the world require their physicians to work in underserved areas as a compensation for a free medical education. Another answer would be to level the compensation for medical fields. Don’t get me wrong, I’m not saying that treating a rash is any less important that treating hypertension, but the compensation should be proportional to the care delivered.
