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Wednesday, February 9, 2011

will there be enough primary care docs to go around?

no, probably not.


There are a couple of articles in the New England Journal of Medicine about the upcoming shortage of primary care doctors as the newly insured finally are able to pay for medical care. This problem will be most acute in the states with the lowest number of primary care physicians and the highest number of uninsured people. Oklahoma tops the list. My state, Idaho, is right in the middle, and Massachusetts will have plenty of primary care capacity.

The challenge is to get enough graduating doctors to choose to go into primary care. Presently there are not enough graduates choosing specialties such as family practice, internal medicine and pediatrics to replace the docs who are retiring. This leaves foreign medical graduates, midlevel providers such as nurse practitioners and physician assistants and specialists to fill the gap. All of these options have limitations. Midlevels can be excellent providers, but don't have the more extensive training that is provided to an MD and can't always handle the complex problems presented by the old, the very sick and folks with a combination of mental and physical illnesses. We still need primary care MDs, and we need more of them. Because primary care has gotten squeezed, by complex requirements on time, low levels of pay for time spent and excessive demand due to shortages, it just doesn't look like that great a deal to become a primary care physician to medical students in the craziness of training. They can't make enough money to pay their humongous student loans and it looks like a never ending rat race.

When I teach medical students, I present a different picture, because my job is wonderful. Nobody could ask for better. It is interesting and the opportunity to think and meet new people is just what I always would have wanted. My workload is manageable because I live in a town that has enough primary care physicians. But most medical students will be mentored by harried, busy and grouchy primary care doctors who work in large groups where they have little say about their schedules.

Dr. Stephen R. Smith, a Dean at Brown University School of Medicine, has written a genuinely well thought-out and heart warming article about how to produce more primary care doctors. I hope that it will come to something because his ideas are excellent.

http://www.nejm.org/doi/full/10.1056/NEJMp1012495

It is excellent to see physicians solving problems like this rather than expecting the federal government to make laws which really can't do what needs to be done.

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