Primary care shortage could worsen under reform

The shortage of primary care physicians could prove a major challenge to health reform. To make matters worse, some doctors are considering early retirement because of the high cost of practicing medicine.

"Among the many hurdles facing President Barack Obama's plan to revamp the nation's health care system is a shortage of primary care physicians — those legions of overworked doctors who provide the front line of medical care for both the sick and those hoping to stay healthy," The Associated Press reports. "As Massachusetts' experience shows, extending health care to 50 million uninsured Americans will only further stress the system and could force many of those newly insured back into costly emergency rooms for routine care if they can't find a primary care doctor, health care observers said."

A study by the Association of American Medical Colleges found that if the current pattern of declining first-year enrollment at American medical schools continues, "the country will have about 159,000 fewer doctors than it needs by 2025." The ideas proposed to fix the problem, "from boosting loan repayment programs for medical students studying primary care to narrowing the salary gap between primary care doctors and specialists like brain surgeons and cardiologists," are all intended to increase the number of primary care physicians. "As part of his health care overhaul, Obama has stressed the need to 'elevate the profile of family care physicians and nurses as opposed to just the specialists who are typically going to make more money'" (LeBlanc, 9/13).

CNN Money reports that "some physicians, fed up with the costs of their practice, are ready to hang up their stethoscopes and shift careers." The article begins with the story of Dr. Tara Wah, an ob/gyn in Tallahassee, Fla., who closed her practice last November because she could "no longer afford to make ends meet." She explained, "Insurance payments for patient care have stayed virtually the same for the last 15 years, while the cost of doing business, including health insurance, staff salaries and supplies have risen." But she adds that the rising cost of malpractice insurance "was the straw that broke the camel's back." Now, Wah "designs and repairs jewelry."

Wah's experience is representative of a larger trend. "A first-ever survey of 12,000 primary care physicians conducted last October by Merritt Hawkins and the Physicians' Foundation, an organization that represent the interests of physicians, showed that 10.1% of respondents planned to seek a job outside of health care in the next one to three years." Kurt Mosley, "a staffing expert with Merritt Hawkins & Associate, a physician search and consulting firm … said it's a waste of training, skill, talent and money when a doctor leaves the profession in mid-career." He adds that it's also a waste of taxpayer money because "medical residency programs are mostly funded by Medicare to the tune of $9 billion to train about 100,000 residents annually, according to the Medicare Payment Advisory Commission" (Kavilanz, 9/14).

But American Medical News reports that medical homes could improve things for doctors and patients alike. "Implementing a patient-centered medical home in Bellevue, Wash., lowered physician burnout rates and improved patients' satisfaction with their care, according to an evaluation of a clinic that incorporated elements of the health care model." The study, published in the September American Journal of Managed Care, "found that the medical home model provided more time for office visits, more preventive care and improved collaboration among health care professionals. A care team meeting was held each morning to review the previous day's activities and plan for the day ahead" (Landers, 9/14).

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This article was reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.