Wednesday, February 13, 2008

Fewer Primary Care Docs

In a shocking report (not really) released by the General Accountability Office (ie - the US federal government), they stated that there are fewer primary care docs now than there was about 10 years ago. The first thing I have to comment about is the name - "General Accountability?" - What's up with that? To whom are they accountable? Let me answer that - nobody!

Anyway, in this Associated Press article, the report goes on to say that in 2006, there were about 22, 146 American docs in residency programs across the United States. In 1995 (when I was in medical school), the number was about 23, 801. For the next few years after that, the number plateaued. Then, right when I graduated is when the fall started to happen.
"It is troubling to me that the number of Americans pursuing a career in primary care has declined," said Sen. Bernie Sanders, I-Vt. Overall growth in the number of primary-care physicians "has been totally due to the number of international medical students training in America," Sanders said. "We are increasingly dependent on international medical school graduates to meet our needs. Currently, one in four new physicians in the U.S. is an international medical graduate."
These quotes just kill me. What do you mean legislators and the federal government don't know and cannot explain why this happened? It confuses and frustrates me because they are the ones, in my opinion, that CAUSED this situation. They did choose and continue to choose to reward specialists, especially those doing procedures, the higher payments. What happened when they did that? Read on...
For specialists, the number of Americans in training went from 45,300 in 1995 to 47,575 in 2006 and over the same period international specialists grew from 11,957 to 12,611, GAO said.
Does anyone know who that is a picture of at the top of this post? That guy is Willie Sutton. That name should ring a bell to some of you - especially history buffs out there. He was one of the most prolific bank robbers of the early 20th century. When asked why he robbed banks, he is attributed with the famous quote, because "that's where the money is."

It's not rocket science. Why did the number of specialists grow during this time? Because that's where the money was (and is). Why did the number of primary care docs shrink? Because that is where the money is not. And, who is filling that primary care gap? It is international medical graduates.

I don't want to start an entire international medical graduates debate. I'm just saying that if graduates from US medical schools are not going into primary care (and that is happening), who are going to fill those residency/training spots?

So, one of these days, the legislators and the government will figure it out. Unfortunately, it will not be until medicare, medicaid, and social security go bankrupt. Or, when the voters (meaning patients) rise up and tell the government something like "Fix the Health Care System Now." Oh yeah, isn't this an election year? Maybe this year? But, probably not....


YS said...

Thanks for the nice article Dr. A

I have a question, I don't know how relevant it is to your post, but I'll ask it anyway:

Do you know how many people are applying to residency programs each year and how many empty residency positions there are in the first place?

Dr. A said...

YS - Thanks for your question. As far as how many residency positions are available, there are a few sources to check out including ERAS, and also some of the specialty sites including AAFP, AAP, ACS and other speciality societies.

As far as how many people are applying and how many slots are open slots, a simple internet search will not help you. That's the type of thing that needs to asked to the people in that specific residency program. Sometimes they tell you over e-mail. But, most of the time, you'll have to make an in-person visit to figure out what's going on.

Anonymous said...

If you were smart enough, you'd realize that in many regions (such as mine) you make more per hour as a nurse than as a family doc.

A family doc

twilite said...

Hi Dr A. An excellent post. I've been wondering about this for some time but... It'll be even more revealing when you follow through. Thank you.

Anonymous said...

Excellent post.

I am proudly married to a family doc. Sadly, she has left the specialty to practice medicine for the gov't. As a family doc, she did the unthinkable - opened a practice where patients had her phone number (like the old days when we grew up), made house calls when really needed (or just the kind thing to do, like the old days), and spent more time with each patient than the insurances alot for. Pretty soon we were juggling each month to pay bills; something we'd never had to do. Medically, she was a huge success. Patients lined up to be seen by her. She gave high quality, compassionate care; but she was not even near fairly compensated. The toll it took out of her to run such a practice in today's insurance managed (hijacked) environment was too much. Now she practices really interesting medicine, has regular hours, regular pay, and benefits. Her patients lost big-time. Where will they find another doc like her?

Oh, the kicker. Over a year after she had closed her office, she was finally getting paid by some insurance companies for patients she had see 14 months ago and more.

That's why all the local boys and girls want to be specialists. Bigger bucks for their efforts. And we all lose.

Anonymous said...

What's really sad, is the fact the primary care doc has a harder job. Most patients come in with vague symptoms that are harder AND TAKE LONGER to sift through, with no extra compensation. It's no wonder they are now called the gatekeepers. Refer the patient as quickly as possible to a specialist, so you can see another patient and afford to keep your practice running. Pitiful!

Anonymous said...

The answer is International Medical Graduates. I hope you do not vilify us (I am one) for this. You make it sound like having IMGs do primary care is a bad thing. We go through the same qualifying examinations and the same residency training local grads do before we set up practice, not to mention the bar is set higher before we could get into a certain training program. We live here too and we are happy to be part of the solution. If local US grads do not go into primary care because they think the money is too little then that is their right as well. But those who are in primary care and keep complaining about the money then perhaps it is time to move on and find something else. This unhappiness can leak through and potentially hurt one's practice if one is so unhappy and insecure about the finances. No one should limit you from finding your place in life. If you are unhappy where you are at, move on.

Of course, you have a very good point about the role of legislation in this. Insurance managed care is really a prick to all of us as patients and as physicians. But I'm sick of hearing or reading about IMGs being used as debate articles, political football, and subject of some disgruntled physicians' demagoguery.

All the best!