U.S. facing shortage of primary care physicians


A recent study reported in the Journal of the American Medical Association has suggested a disturbing trend. Of 1,200 fourth-year medical students surveyed, only 2 percent reported plans to enter primary care internal medicine. If this result is realized, the shortage of primary physicians will become acute.

Medical education planners are aware of the relative disdain doctors-in-training have for the primary care specialties: family medicine, internal medicine and pediatrics. Most medical students apparently prefer subspecialty careers which are much more lucrative. However, I recently heard of plans to force medical students into primary care.

The supervising board to which the specialty medical boards belong are discussing reducing the total number of subspecialty training slots available to graduating doctors. For new doctors, the competition for specialties such as orthopedics or ophthalmology, would be cutthroat in nature.

In my opinion, medical education has enough of that atmosphere already. Nevertheless, if implemented, many student doctors would have to go into primary care, not by choice, but because there is very limited opportunity to do anything else. I believe there are several drawbacks to this approach.

First, the practice of medicine, if not what a physician wants to be doing, can be very dissatisfying. We’re already seeing an accelerating retirement rate among older, unhappy doctors. If older doctors are leaving, and newer doctors find themselves in primary care while desiring to be elsewhere, and begin to leave, we will see a tremendous shortage of physicians.

I doubt that restricting subspecialty training numbers will work. Also, especially in the community I currently practice in, there is a shortage of sub-specialists.

Of course, foreign-trained physicians are becoming more numerous because of the current shortage of doctors in all specialties, especially in nonurban locales. One wonders what the free market could do if left to deal with this situation.

Unfortunately, medical markets do not always respond to market forces in ways comparable to other businesses. For example, the doubling of CAT scan machines or MRI imagers in a single community rarely decreases the cost of using those services.

Still, if the disparity between primary care and subspecialty care salaries were more equitable, perhaps more graduating doctors would be attracted to primary care.

My real concern is that the smartest of our young people will avoid a medical education altogether without the promise of competitive pay and quality of life they expect as a return for such a huge sacrifice of personal time and treasure. The average graduating doctor has educational indebtedness approaching that needed to purchase a nice home. Then comes the residency training years which are arduous and poorly paid. Total time commitment to become a doctor, not counting a four-year college degree, includes four years of medical school and three to six years of residency training.

The realities of finding a doctor in the future already are being seen. There are fewer MDs and more physician assistants, nurse practitioners and other alternative medical practitioners increasingly filling the void in communities nationwide. This latter trend will continue and accelerate. Older, more experienced doctors will continue to retire early, and the really smart students will go into law or seek their MBAs.

Who would have ever expected that avoiding a medical education would be considered the “smart play.”

Dan Gold is medical director at Big Sandy Medical Center. The Healer’s Corner is a general information medical column and is not intended for use in self-diagnosis and treatment of individual medical problems. E-mail him at thehealerscorner@mac.com.

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