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The Primary Care Shortage: Killing The Golden Egg-Laying Goose?

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.


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2 Responses to “The Primary Care Shortage: Killing The Golden Egg-Laying Goose?”

  1. Art says:

    I wonder who will write a comprehensive article on how we are knowingly and perhaps willingly causing an implosion of our healthcare and calling it reform?

    Physicians are either becoming “industrialized” into groups so their clerking requirements can be done by others and they can have “9 to 5″ jobs 5 days a week [which will lower the amounts of patients they can care for], or doing the same through large hospital groups.

    Those who are doing this are mainly the younger physicians as the older ones are of the “old school” and consider their work a profession and not a job, where hours, quality time with family and freinds were not as important as delivering quality care whatever the time or needs might be. And the decrease in interest to be primary care physicans continues to attract fewer medical students who see this field as being overworked and underpaid.

    To make up the currently needed numbers of primary care physicians, [since it takes 10 years to produce them if possible] will only be able to have them available in 2020; while there seems to be thousands of “unfulfilled and disappointed primary care physicians who average half of what specialists do, who can only look forward to treating more patients with greater problems and to being forced into “groups” so they can retain their sanity by working fewer hours treating fewer patients as their younger FP and GP counterparts do, retire, change fields or become specialists.

    So over the next few years and hopefully before 2012 we will see how or if healthcare reform improves care by open access. By 2020 there will be 60 million more people with government provided Medicare, Medicaid and “exchange” insurnace, but by 2012 we will know we have a problem Washington! The huge demand has no supply capable of filling it!

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