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Facing America's Doctor Disparity
April 10, 2009 8:08 PM
ABC News Medical Editor Dr. Tim Johnson reports: In response to my report on Primary Care on “World News” Thursday, I have received several comments requesting some ideas on how to improve the supply of primary care doctors -- general internists, family physicians and pediatricians.First, a reminder: almost all industrialized countries strike a 50-50 balance between the numbers of primary care doctors versus specialists. But in this country the distribution is about 70-30, specialists versus primary care. And it's getting worse -- trending down every year.
One survey of graduating medical students indicated that only 2 percent were thinking of general internal medicine! And there is a joke among medical students that when they graduate, they are going to go "on the road" -- meaning they will try to choose among radiology, ophthalmology, anesthesiology or dermatology (ROAD).
The reasons are fairly obvious: better pay, shorter hours, less night and weekend calls and, therefore, better lifestyles.
So why do medical students in other countries choose primary care more often? There are many reasons but, again, some are obvious. Many of these countries make medical education much more affordable, even tuition-free, so that medical students do not graduate with huge debts that they must struggle to pay off. They also work at providing better working conditions for primary care doctors, such as reasonable night and weekend coverage.
Many studies now show that when good primary care is available, health care costs go down and quality rises -- which is to say that unless we work at providing more primary care in this country, true health care reform will be impossible.
P.S. -- We must also work at increasing the supply of nurse practitioners and physician assistants who can supply much of the expertise needed for good primary care. In fact, many experts now refer to "medical homes" as a combination of doctors, nurses and assistants who provide primary care.
April 10, 2009 | Permalink | User Comments (6)
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NPs and PAs are doing such a good job.Especially NPs that provide medical care in remote areas around the cities.
Posted by: Rebecca Etta | Apr 11, 2009 12:55:34 AM
Affordable medical education and better working hours would help but doctors in other countries do not face the vicious, predatory legal environment and do not have to carry the associated prohibitively expensive malpractice insurance like doctors in the U.S. Maybe medical students choose specialties not just for the better lifestyle but because the better pay buys better insurance versus the next opportunistic lawsuit.
Posted by: bct | Apr 11, 2009 8:11:38 AM
I always enjoy Dr. Johnson's thoughtful analyses. I think many of us physicians know the problem intimately. Physicians are faced with longer hours, less pay, more regulation, high malpractice costs and less respect. We have to beg the government every year just to keep Medicare reimbursements level. New regulations abound (did you know your doctor is now considered your creditor?). We have to deal with just under a billion insurance plans. The list goes on...
So at least there are moves going on to try to fix things but these are a way off. This primary vs. specialty care thing is a hoodwink to some degree. For example, Ophthalmology is mentioned above but the actual projections show a shortage of Ophthalmologists in the next 10 years.
The bigger problem is not so much of a lack of primary care doctors, but that they aren't located in rural ("underserved") areas. Same goes for specialists...
Posted by: doc | Apr 11, 2009 11:20:00 AM
Specialist earnings are higher than primary care physicians. The medical field is disappointing to the newly graduated medical doctors.....leaving schools with as much as 200,000 dollars in debt, and finding out that they have to be in a 'managed care organization' just to practice in their fields. The insurance companies owns the doctors in America..........greed! Why not go back to basics while their "Oaths" mean something other than the money. Doctors become doctors to help others because they care...at least that's what it used to be.
Posted by: sngeorgia | Apr 11, 2009 11:20:51 AM
Finally something on the impending, nay ongoing, failure of Primary Care. Insuring "everyone" without a Primary Care Doctor to see them is a currency without a marketplace - just like in Massachusetts.
Primary care is DEAD. Now is not the time for band-aids or oral Amoxil, rather intracardiac epinephrine & countershock.
I CLOSED my Primary Care practice in November 2007 having made $30,000 in my last year as a PMD in favor of Hospitalist work. At least I get paid now.
No one will follow me or my generation into Primary Care as it currently stands due to ruinous discounting by Medicare, Blue (double) Cross and the rest of the 4 letter words; HMO's, PPO's, etc. Medical Students aren't stupid, our politicians are.
Preventive care & coordination - particularly in the elderly with multiple chronic conditions on multiple medications - is best done by Internists; not PA's or FNP's. Yet this is precisely the group that has been most affected by the Insurance monopoly and Medicare's lack of support, neglect and out-&-out persecution.
All "universal" care system around the world, when they actually work, are based on a vibrant, well-paid Primary Care staff. All the studies support Primary Care as cost saving and life-saving. So why are we dismantling it here?
I.M. Primary Care is simply not viable currently, when specialties like Derm & Ophth are clean, easy and make 4-5 TIMES as much. Not to mention that there are VERY few times these Drs. get called to the E.D.
They have to make I.M. PROFITABLE (so you can pay back the huge debts AND have something to show for all those years of delayed gratification & wage earning for retirement) & on a par - if not better - than most sub-specialties.
Stop the ruinously low fees, stop the ridiculous bureaucratic overburdening, stop the insurance industry from making medical decisions without a license or consequences when (not if) it all goes wrong.
Save Primary Care now - or we will ALL suffer the consequences - and it will take a decade or more to fix.
Richard E. Sacks-Wilner, MD
Posted by: Richard E. Sacks-Wilner, MD | Apr 17, 2009 8:43:45 PM
I think the need to improve the reimbursement structure for primary care services is critical. The main reason the subspecialities are very attractive to medical students is that they make more money by doing more procedures. By decreasing the disparity of reimbursements for procedures and primary care, one can increase the attractiveness of primary care.
Posted by: John Smith MD | Apr 22, 2009 3:03:54 PM
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