More Primary Care Physicians Are Needed.
As I mentioned in previous blogs, few people pay attention to the law of unintended consequences of legislation. The example set in Massachusetts has shown that with some success (97% coverage), there can be the beginnings of failure. In other words, when you suddenly have a large group of people who are insured and ENCOURAGED to get preventative care, where do they go? To their Primary Care Physician. The result? Very long waits to see their physician, which is measured in months, not weeks. Also, more visits to the emergency department. And this leads to increased costs. And this happens in Massachusetts which has more physicians per capita than any state in the nation.
Currently, in the U.S. we have a shortage of Primary Care Doctors (PMDs). In 2005, the Council on Graduate Medical Education released a report predicting a shortage of about 85,000 physicians by 2020 (which will be worse if the older MDs wary of healthcare reform retire as they are threatening to do).
The American Academy of Family Physicians recommended that to meet the need for primary care physicians in 2020, the United States would have to train 3,725 family physicians and 714 osteopathic physicians annually. This is just the recommended Family Practitioners and does not address other PMDs that are needed such as Internists.
In 2007, only 1107 medical students matched into Primary Care residencies. It takes 3 years to train a PMD. If this year (2009) we tripled the number of Primary Care matches, the country would still be 40,000 PMDs short.
The GAO study GAO-08-472T found that preventative care, coordinated care for the chronically ill, and continuity of care can achieve better health outcomes and cost savings. The study also found that states with more primary care physicians per capita have better health outcomes than states with fewer primary care physicians, and that states with a higher generalist-to-population ration have lower per-beneficiary Medicare expenditures.
IT WOULD BE IRRESPONSIBLE TO INITIATE A UNIVERSAL HEALTH CARE PLAN WITHOUT FIRST INITIATING A PROGRAM TO DRAMATICALLY INCREASE THE NUMBER OF PMDs (But also medical students overall as there is also a projected shortage of surgeons as well)
This means we need more money for physical infrastructure in medical schools to accommodate such a large increase in students. Also, more money for residency spots (it takes approximately $100,000/year to train a physician). Finally, I highly support government subsidization of medical school tuition to minimize student debt as students with large amounts of debt tend to pick higher paying specialties (in other words, NOT primary care).
To meet the short term demand for increased primary care, a number of creative solutions must be enacted. I have a few suggestions:
1) Increase physician productivity by elimination of non-patient duties:
- Documentation (have government subsidies for scribes)
- Pre-approvals (hopefully patients in health markets/exchanges or Medicare will not need pre-approvals as this costs tons of money in physician productivity and unnecessary admnistrative costs)
3) Encourage US-Trained foreign residents to stay in the US.
4) Create a pathway for foreign-trained primary care doctors who speak good English (particularly Australia/UK/Canadian trained) to do a one year primary care appenticeship under a board-certified IM or FP physician, followed by an exam to allow them to obtain a license to practice.
5) Give tax breaks or other incentives to semi-retired/recently retired primary care physicians to bring them back into the workforce. (via L.Saldana MD)
Getting more PMDs won't be fast. And it won't be easy. But if we want USEABLE Universal Health Care, then it must be done.
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