Perspective: A mixed job report for primary care

May 16, 2008

Increasingly, primary care is one of those things Americans don't want to do.

Viewed from one angle, the primary care job picture is looking rosier. For the period 2006 to 2007, for example, FPs, internists, and hospitalists led the list of top 20 recruitment searches by Merritt Hawkins & Associates, the national physician search and consulting firm.

In 2006, the last year for which the firm has survey numbers, 79 percent of PCP residents said they'd received 26 or more job solicitations during the course of their training, up from 22 percent of PCP residents who received that many solicitations in 2001.

The increased demand for primary care shows up at the state level, too. In New York, for instance, primary care physicians who finished training in 2007 received an average of 3.7 job offers, compared to 2.7 offers in 2002, according to a recent report by the Center for Workforce Studies at the University of Albany's School of Public Health. This was the first time in 10 years that the average number of job offers for PCPs in New York equaled the number for specialists.

Graduates survey their prospects

This is good news for newly minted and upcoming graduates, of course. But the rosy scenario hides a slightly darker reality.

Besides increased demand, another reason jobs in primary care are more plentiful now is that there are fewer residents to fill them, especially in family practice. According to the Association of American Medical Colleges, the number of US residents in family practice declined from approximately 9,800 to 9,395 between 2001 and 2006. The number of residency slots in internal medicine increased slightly during this same period, although the percentage of graduates who go on to practice general internal medicine has gone down dramatically. The number of residents entering pediatrics or obstetrics and gynecology has remained virtually flat.

So why the continuing shortage in primary care? In a word, money, despite a boost in financial incentives for new recruits beginning last year. Even today, medical graduates shouldering huge debts survey the practice landscape and see a real disconnect between the hours PCPs put in and their incomes, at least compared with specialists and surgeons. Compounding the problem is graduates' perception that, as PCPs, they'll occupy a lower rank in the medical pecking order. No wonder, then, that primary care practice still isn't a big draw, at least not for US medical residents.

"Increasingly, primary care is one of those things Americans don't want to do," says Phil Miller, a spokesman for Merritt Hawkins. One state that's found that out the hard way is Massachusetts, where the gap between supply and demand has been "exacerbated by the state's new law requiring residents to have health insurance," according to a recent story in The New York Times.

A change in workforce and payment policies would help boost the supply of PCPs, the American College of Physicians argues. None of the presidential candidates has specifically addressed these issues, however, at least not to the satisfaction of the ACP.

That's too bad. Whoever takes the oath of office in 2009, the future of primary care needs to be on the agenda.