Is Medical Student Creating a Shortage of Primary Care Physicians?

Over the past few years, rising medical school costs have caused a significant discrepancy in the number of primary-care physicians practicing in the U.S. In fact, according to American Association of Medical Colleges (AAMC), recent data has shown that medical school tuition is up between 4% and 7% from last year. Adding to the burden of paying for this education and a shortage in primary-care physicians is also the fact that “a continually widening gap between general-practitioner and specialist salaries is growing, making the career choice for medical students a fairly easy one: get a specialty.”

These numbers are particularly disturbing because as a recent article in Time Magazine addressed, it “will lead to an acute shortage of these doctors in the years ahead, when retiring baby boomers will need them most.” And a recent study conducted by Dr. Karen Hauer, published in the Journal of the American Medical (JAMA) did not show much hope.

For example, the study found that in the education pipeline, “less than 2% of current medical students are interested in general internal medicine and 4.9% in family-care practice.” For some, this data is no mystery. They clearly acknowledge that the reason why “the general practitioner (GP) is a dying breed, is because of rising medical-school costs.”

Demonstrating the difference in salaries, the Medical Group Management Association’s 2010 physician-compensation report showed that in 2009, primary-care doctors earned a median salary of $191,401; Cardiologists earned a median of $457,310 and dermatologists made $385,088 — doctors who owned their practices earned much more, on average. This income, while high, does not say much to medical-school student graduates who have $200,000 in loans, which does not include debt related to college loans, which can bring the total to nearly $500,000.

Another reason why students are turning away from GP or family medicine is because what income they do make is often “not enough to cover costs of running a clinic because the insurance is high.” As a result, a number of clinics have already closed over the past few years.” The ones that have stayed open have had to take on more patients to pay the bills, and this causes “the quality of care to go down, which is a huge deterrent,” for GPs.

Consequently, “the trend away from family practice is already producing shortages in rural areas and could produce a national doctor crisis in just a few years.” As Dr. Atul Grover, chief advocacy officer for the AAMC noted, “unless more primary-care physicians are recruited, the AAMC estimates a shortage of 30,000 doctors by 2015, and in 10 years, this shortage could go up to 150,000.” Accordingly, since it takes seven years to train a doctor, Dr. Grover asserted that action needs to be taken now.

While “the recent passage of health care reform legislation offers some improvement to primary-care doctors,” most of the reform is insufficient. Despite the fact that “the new legislation adds a 10% bonus to primary-care physicians’ Medicare reimbursement salaries,” these changes  “are nowhere near enough.” Dr. Lori Heim, president of the AAFP asserted that doctors in primary care “need to see a 30% to 50% increase in salaries overall to make any real change in the system.”

There also need to be similar changes to work demands, so that primary care physicians see similar schedules as specialists. GPs and family practitioners also need to have better incentives to maintain their practices and clinics, and resources to afford staff, and the ability to handle a reasonable number of patients.

Ultimately, if Congress had only listened to AAMC of AAFP when it was drawing up health care reform, this crisis may have been averted. Instead, we have to bring 150,000 primary care physicians into the system over the next few years because we are adding 30 million people to our health care system. Since it takes seven years to make a physician, our future appears troubled. Accordingly, policymakers must begin discussing ways to increase reimbursement for GPs and family physicians, create incentives for their practices, and find ways to entice medical students to enter into this field before our shortage of doctors turns into a crisis.