Can anything be done to solve the PCP shortage crisis?

April 24, 2017

Last year, just one in 10 U.S. medical school graduates went into family medicine and the Association of American Medical Colleges predicts that the U.S. will be short by as many as 43,000 primary care doctors by 2030.

Last year, just one in 10 U.S. medical school graduates went into family medicine and the Association of American Medical Colleges predicts that the U.S. will be short by as many as 43,000 primary care doctors by 2030.

 

Further reading: How federal policy has worsened the U.S. primary care shortage

 

Wayne Lipton, founder and CEO of Concierge Choice Physicians, a concierge group with more than 200 affiliate physicians in 23 states, believes that being a primary care physician is not as appealing as it was in the past.

“As a nation, we undervalue the role of the PCPs. This is a direct result of the workload, level of detail reporting, exposure to liability, compensation, control of care decisions, competition with lower level providers, financial obligations from education and opportunities for growth,” he says. “It has also become less appealing to entrepreneurial physicians and more appealing to those who just want a salary and a shift.”

G. Richard Olds, MD, president of St. George’s University, notes that while U.S. medical schools aren’t producing enough primary care physicians, the shortage of doctors is also uneven. For instance, in California, there are 86 primary care physicians per 100,000 residents in the San Francisco Bay Area, but just 48 per 100,000 in the largely rural San Joaquin Valley and 43 per 100,000 in the Inland Empire east of Los Angeles.

“That’s partly due to the socioeconomic status of U.S. medical students. A staggering 80% come from families that are in the top two-fifths of economic status,” he says. “This makes it less likely for those students to work in underserved communities.”

Additionally, most of the faculty in U.S. medical schools are specialists, and Olds feels they look down on students who go into primary care.

“Most training in U.S. medical schools is inpatient-based and at large, tertiary referral hospitals that focus on specialty care,” he says. “Students spend little or no time in the outpatient and community settings, which means they’re less likely to go into primary care.” 

 

Blog: Here is the PCP crisis solution and it's simple

 

Boyd R. Buser, DO, dean of the Kentucky College of Osteopathic Medicine feels a contributing factor for the decreased percentage of physicians entering primary care is the increasing debt load that graduating medical students are incurring, coupled with the fact that primary care specialties are among the lower paying specialty choices. 

“Despite this financial disincentive, we still see a robust number of graduating osteopathic physicians choosing primary care residencies,” he says. “Osteopathic principles of patient care, with an emphasis on disease prevention and wellness, lend themselves especially well to primary care.”

Next: The government's role

 

The Government’s role

Many in the industry believe that the government could subsidize the costs of medical education for PCPs to get more people interested in the field.

“It might require services to either underserved geographies or underserved populations, or a commitment to remaining a PCP for some time,” Lipton says. “I would like to see an expansion of The National Health Services Corp., which has about 1,100 people in a variety of medical areas in training at this time. It could be seriously increased if it got even more funding, however, the repayment amounts are inadequate for most PCPs.”

 

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Charles E. Crutchfield III, MD, adjunct professor at the University of Minnesota Medical School, worries about where the applicant pool would come from if the country trained more doctors.

“If we used the same applicant pool we have now to increase the number trained, we would have to accept doctors form the group of applicants that would normally be rejected,” he says. “You would increase the raw number of doctors but the quality may suffer.”

Buser says the problem restricting growth of the U.S. physician supply is not at the medical school level, but instead lies with the cap on federal funding of residencies (graduate medical education or GME). 

“Expanding and reforming GME payment policies could favorably affect both the geographic and specialty maldistribution of the physician workforce, as well as increase the physician supply,” he says. Funding for Teaching Health Centers, which provide a community-based model of training for primary care residents, is set to expire on Sept 30.

Next: International impact

 

International impact

A larger number of Caribbean-educated U.S. medical students choose to specialize in primary care. For instance, Olds says that three-quarters of the students he teaches go into primary care.

“Graduates of international medical schools are essential to alleviating the U.S. doctor shortage, especially in high-need areas,” he says. “International medical graduates are picking up the slack.”

 

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However, numerous health experts warn that recent health care and immigration policies could worsen the ongoing doctor shortage.

Lipton says some foreign-born physicians, trained in their own countries, often become primary care physicians. However, if the number of immigrants declines, that could impact the overall number of PCPs in the U.S.

According to the Centers for Disease Control and Prevention, internationally trained doctors are more likely than their U.S.-educated peers to treat patients who are underserved by the U.S. health system, including minorities, those born abroad and those on Medicaid.

“Tougher immigration laws could devastate the communities that depend on international medical graduates to meet their primary care needs,” Olds says.