This past Monday, I was drawn to an article in the Wall Street Journal: “Medical Schools Can’t Keep Up.” The article detailed the growing shortage of primary care doctors in our country and reminded me that we in the U.S. may have something called “insurance reform” now, but without physicians to translate insurance access into healthcare, the state of our healthcare system will continue to beg additional attention and reform.
Although new medical schools are opening and some schools have increased enrollment numbers, there are a limited number of residency positions in this country. The government has always funded these residency positions and our new reform law tries to address the primary care shortage with “slot redistribution,” whereby money from unused residency positions will be deferred to primary care or general surgery residency programs.
However, the slot redistribution strategy equates to something of a shell game when set against the fact that in 1997 Congress put a cap on funding for medical residencies, and this limit is still in place today.
Too, we must take into account that it takes time to train doctors. Students desiring to become physicians must be motivated to endure the long training periods involved. Over the 11 years of my training (4 for college + 4 years accruing debt as a medical student + 3 years as a resident), I was acutely aware of the concept of delayed gratification. Sometime in college my father told me that he’d never seen a doctor starve to death. This observation–intended as wit– helped to illustrate the fact that I would have job security and a comfortable living in the future, a fact that did help motivate me through inevitable rough patches.
The well spoken and timeless adage, “Man does not live on bread alone,” should help us to understand that tomorrow’s physicians will not be motivated solely by the promise of job security or a comfortable salary. Debt forgiveness to serve in underserved areas may lure graduates towards primary care but I harbor my doubts that this will make up the 150,000 doctor shortage, as estimated by the Association of American Medical Colleges. A 2007 survey of practicing physicians found that between 30 and 40 percent would not choose to enter the medical profession if they were deciding on a career again. Thirty five years earlier, the same survey found the number closer to 15 percent. There is real risk in ignoring the reasons for such dissatisfaction–we could run out of primary care doctors, a resource as irreplaceable as Aesop’s golden egg-laying goose.
As a young man, I felt a calling towards the profession of medicine and still do today, but I constantly battle against becoming something altogether different. A good friend of mine, an orthopedic surgeon, best explained it when he told me that he “is a part-time surgeon but a full time clerk.” He lamented the time spent focusing on medical codes, charting, and cataloging supplies while attending mandatory meetings on everything but medical knowledge. He plans to retire soon and actually wringed his hands with anticipation while sharing his plans with me to volunteer in the third world so he can “become a full-time surgeon again by becoming a part-time doctor.”
Today, we in the U.S. have insurance reform but needed health reform. Talking heads on TV are now asking how to “bend the cost-curve downward” and are starting to ask who will see the patients if there aren’t enough primary care doctors to implement insurance reform. All good questions but I would pose one more. How can we expect our youth to sacrifice years of their lives, amass six-figure debt, and move towards a profession that leaves them dependent on government money and beholden to onerous and often nonsensical government rules and regulations? Our society should take care lest we kill our goose and run out of golden eggs.
Until next week, I remain yours in primary care,
Steve Simmons, M.D.