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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)