Friday, September 19, 2008

The Growing Primary Care Gap

There was a recent study published in the Journal of the American Medical Association and mentioned throughout the media. The study involved surveying medical students to asses what percentage of them were interested in pursuing careers in primary care medicine. Primary care generally refers to family medicine, pediatrics, or internal medicine. Out of 1,200 medical students surveyed, only 2% were planning in pursuing a career in primary care and are instead hoping on becoming specialists.

Briefly, the main reasons cited by students for not wanting to pursue primary care included:
  • Having to deal with too much “paperwork”
  • The increasing demands that will ensue when caring for the growing elderly population
  • The need to bring work into the home
  • The salary gap that exists between PCP’s and specialists
  • The increasing amount of debt upon graduation
  • Time pressures when caring for so many patients with inadequate resources
Essentially, the study suggests that student are deterred by three factors - salary, autonomy, and insurance bureaucracy. It is no surprise why students would rather pursue more lucrative specialties. However, it will be interesting to see how many of the survey participants will actually match into the specialty of their choice (apparently, non-primary care). Many of them will face the harsh reality that without high USMLE scores and polished CV’s that include research, their competition for those highly sought non-primary-care specialties will be fierce. For those who have their sights on Dermatology, Ophthalmology, ENT or Ortho, lets hope they do not feel slapped in the face when they open their white envelopes on match day. There are limited slots each year for each specialty, and its unfortunate that many of the U.S. medical graduates are leaving most primary care residency slots unfilled, such that even international medical graduates (IMGs) cannot satisfy all the needed vacancies. No offense to IMGs, but this reality is disheartening. As future health professionals, we are supposed to herald disease prevention as the first line of defense against disease. We are well aware (I hope…) how research has established primary care medicine as the most effective approach to health promotion. Alternatively, health policy experts also tend to agree that primary care should be the emphasis of attention in the solution to our healthcare crisis revolving around access, quality, and cost. So why are 98 out 100 medical students undermining the solution? Are we part of the problem, or is it the delivery system itself ?

I don’t presume to know the answer, but it is reasonable to suggest that as students who were raised and trained in a capitalistic nation, we are likely to view our education as a long-term investment that should yield the maximum product for our venture. The product herein being job satisfaction and the investment being the 12+ years of training one must undergo before even being eligible for Board Certification. Regardless of our reasons, if we continue at this rate, the primary care gap will worsen.

On another note, we should be wondering what measures are being proposed to address this concern. According to the article, congress is being called to create a “permanent regulatory commission to encourage training for needed specialties.” I guess we could really use some “encouragement”- whatever that means…


Metzonalli said...

Hola.. encontré tu blog mientras buscaba en Internet sobre la UCLA... ( Yo estaba considerando esa universidad, el problema es que soy de México, entonces tengo varias dudas.. me metí a la página pero no está tan claro como quisiera.
Me preguntaba si podrías ayudarme. Sin compromiso ni nada... si te da mucha flojera o lo que sea no pasa nada :P.
Aquí está mi mail:
De antemano agradezco tu tiempo

Rusty Scalpel said...

I wonder if the answer for many of those attempting to escape the rat race of primary care is fee for service practices. Participating physicians will likely see salaries comparable to those of other primary care docs, but they will escape the bureaucracy associated with insurances companies. They will have better control of their practices and their lives and be able to focus on healing instead of quotas and paperwork.