Wednesday, September 10, 2008

primary care shortage

All the buzz in the media and on doctor blogs in the past day or two has been the announcement that, according to a survey published in the Journal of American Medical Association, only 2 percent of graduating medical students are going into primary care, primarily due to poor salaries and increased workloads. TWO PERCENT!!!!!! That is just frightening to think about, especially from the viewpoint of an already busy rural pediatrician. We, as primary care physicians, are already pushed to see as many patients as possible by our reimbursement schedules. I know that I am getting busier every season than I was the last. This year, my "slow" period consisted of approximately two weeks of slower days, then we picked right back, last year, my "slow" period lasted closer to one month; this year, I'm already seeing winter time numbers with school having been in session only for a few weeks....I'm afraid things will only get worse.

How about talking about solutions to this problem?! Neither candidate is addressing this specific problems. Then again, nobody is really asking them to. I have a proposal: mandatory one to two year service in primary care medicine prior to specialization. In other countries such as New Zealand, they have general practitioners (GPs) who tend to the primary care needs of their citizens. Perhaps we could do something like that here in the US. I have just recently completed my service time for the National Health Service Corps and although that system is severely flawed, it could be used a loose guide. I am now free to do a fellowship, if I so desire. I've learned a lot from practicing this kind of remote primary care medicine, and I think this type of background would serve me well were I to do further training.

This is by no means a perfect solution, and I'm sure I'm not the first to suggest it, but perhaps it could get people talking if it were put out on the table. I know that we, as physicians, already go through many years of training, and some would groan at an additional two years, but how else will we take care of an increasing population of baby boomers?? We cannot simply rely on foreign medical grads. We cannot rely on the whims of medical students. And, at least at this point, we cannot rely on improved salaries to draw medical students to primary care.


thecountrydocreport said...

While the numbers of med students going into primary care is bleak, it is not as bleak as the media has reported. The JAMA article reported shows that only 2% of internal medicine residents plan to go into primary care. The study didn't look at pediatrics or family medicine. The only thing sadder and the numbers going into general internal medicine is that the media still doesn't know what primary care means.

Alex Cvijanovich said...

That is true! But we are getting into a desparate situation. Maybe with the National Service plan, we can improve...
Thanks for your comment!