Bolster primary care: Avert a physician shortage
■ The AMA is pursuing efforts to make primary care more rewarding and appealing to doctors.
Posted Jan. 5, 2009.
Reports are gloomy these days about current and future shortages of physicians -- especially in primary care.
For example, a November 2008 white paper by the American College of Physicians said the number of U.S. medical graduates entering residencies in family medicine and internal medicine has declined by half in the last decade. Graduates are seeking higher-paying specialties over the longer hours and lower pay of primary care.
The same month, the Physicians' Foundation released a survey of 11,950 physicians that said 78% of respondents believe there is a shortage in primary care. About half of all surveyed doctors said they plan to reduce their patient loads or stop practicing within the next three years. Also in November, a report by the Assn. of American Medical Colleges projected a shortage of as many as 150,000 physicians by 2025 that will impact all specialties.
Work force studies in 2008 by medical societies in Massachusetts, Wisconsin and Connecticut said more doctors are needed to meet growing patient needs, with primary care physicians in high demand. The Massachusetts Medical Society report showed that 12 of 18 specialties studied are in short supply, double the number from three years ago. A Connecticut State Medical Society study of 1,077 physicians found that 19% of doctors are considering a career change.
Aging baby boomers are one key reason why work force experts believe shortages will befall primary care and other specialties, making it more difficult for Americans to find medical care. A 2008 Institute of Medicine report said there will not be enough geriatricians when the 78 million baby boomers begin to turn 65 in 2011. And with fewer medical graduates choosing primary care, the strain is only expected to worsen.
The American Medical Association and other physician organizations are calling for changes to help physicians with medical school debts, which average about $140,000, and are looking to develop ways to recruit primary care doctors. At its Interim Meeting in November 2008, the AMA's House of Delegates adopted new policy to address recruitment and training, medical student debt and reimbursement for primary care. The action bolstered existing AMA policy that supports an adequate primary care work force and backs enhancement of financial aid options for students choosing primary care.
The new policy supports programs, such as loan repayment plans, that decrease the educational debt load of doctors who choose primary care practice. The Association also will continue to track trends in primary care and the availability of primary care residencies.
The policy also calls for the AMA to collaborate with other organizations, such as medical schools, to develop innovative ways to recruit and train primary care physicians. As it strives to reverse the physician shortage, the AMA says physicians, medical schools and lawmakers should work together to guarantee adequate access to care for patients. The AMA also will study emerging models such as the medical home concept and will work with specialty societies to advocate for reimbursement for primary care services.
In the political sphere, Sen. Max Baucus (D, Mont.), chair of the Senate Finance Committee, introduced a reform plan in November 2008 that would provide additional pay for primary care services in Medicare and expand testing of the medical home model in Medicare. The AMA said it looks forward to working with Baucus and other congressional leaders to improve the health care system.
At the same time, President-elect Barack Obama's plans to support primary care include offering loan help and improving payments.
It is a frightening prospect to not have enough physicians to provide care, all the more so with an aging population. The warning signs are clear and consistent, and turning this situation around will take years. The time to start addressing these shortages is now.