Fewer US Med Students Choosing Primary Care

By CARLA K. JOHNSON – September 9, 2008 

CHICAGO (AP) — Only 2 percent of graduating medical students say they plan to work in primary care internal medicine, raising worries about a looming shortage of the first-stop doctors who used to be the backbone of the American medical system.

The results of a new survey being published Wednesday suggest more medical students, many of them saddled with debt, are opting for more lucrative specialties.

Just 2 percent of nearly 1,200 fourth-year students surveyed planned to work in primary care internal medicine, according to results published in the Journal of the American Medical Association. In a similar survey in 1990, the figure was 9 percent.

Paperwork, the demands of the chronically sick and the need to bring work home are among the factors pushing young doctors away from careers in primary care, the survey found.

"I didn't want to fight the insurance companies," said Dr. Jason Shipman, 36, a radiology resident at Vanderbilt University Medical Center in Nashville, Tenn., who is carrying $150,000 in student debt.

Primary care doctors he met as a student had to "speed to see enough patients to make a reasonable living," Shipman said.

Dr. Karen Hauer of the University of California, San Francisco, the study's lead author, said it's hard work taking care of the chronically ill, the elderly and people with complex diseases — "especially when you're doing it with time pressures and inadequate resources."

The salary gap may be another reason. More pay in a particular specialty tends to mean more U.S. medical school graduates fill residencies in those fields at teaching hospitals, Dr. Mark Ebell of the University of Georgia found in a separate study.

Family medicine had the lowest average salary last year, $186,000, and the lowest share of residency slots filled by U.S. students, 42 percent. Orthopedic surgery paid $436,000, and 94 percent of residency slots were filled by U.S students.

Meanwhile, medical school is getting more expensive. The average graduate last year had $140,000 in student debt, up nearly 8 percent from the previous year, according to the Association of American Medical Colleges.

Another likely factor: Medicare's fee schedule pays less for office visits than for simple procedures, according to the American College of Physicians, which reported in 2006 that the nation's primary care system is "at grave risk of collapse."

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I have learned that the greater part of our misery or unhappiness is determined not by our circumstance but by our disposition. MARTHA WASHINGTON

As baby boomers retire and go onto Medicare, will their be adequate primary physicians to treat them?  Finding primary physicians that accept Medicare is already a problem for some in certain areas.  As people age and live longer, they generally have one or more chronic health conditions that needs monitoring and treatment.  Having access to treatment from a primary physician would ideally help control health care costs by maintaining a patient's health and keeping them from requiring more expensive care, i.e., controlling diabetes, high blood pressure or high cholesterol minimize heart disease.

There has been a shift of voters attention to the disturbing state of our economy, but we cannot lose sight of the critical need for health care reform, escalating health care costs also impact our economy. 

  

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I have learned that the greater part of our misery or unhappiness is determined not by our circumstance but by our disposition. MARTHA WASHINGTON

Many express a concern about government involvement in health care choices, but I hear a lot of complaints and concerns about our current public and "private" health care system.  People with preexisting conditions are denied from purchasing individual health plans or have to pay high premiums.  Drugs may not be on a plan's formulary list or they may be designated as a Tier 4 drug and cost the insuree hundreds of dollars a month.  Premiums, copays and out of pocket expenses go up each year, increasing at a rate outpacing inflation and the cost of living.

Health care reform doesn't mean "government run health care" or "socialized medicine."  There are many steps that can be taken to help control costs yet provide affordable access.  Prevention and wellness programs, greater use of information technology, and patient centered "medical homes" that put primary physicians in charge of coordinating care, ensuring better outcomes and ultimately controlling costs.

So many other countries (Japan, Taiwan, Germany, France, UK, Canada, Australia, Switzerland, Netherlands, New Zealand) provide health care to ALL their citizens and pay LESS than we do and we leave 47 million out.  Why can't we do better?  We don't have to copy their health care systems, but surely this great country can create a public/private system that better serves its citizens.  It won't be an easy transition, it will take years and perhaps an initial investment but it would be a more sustainable health care system than what we have now with health care costs expected to double in 10 years.

     

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I have learned that the greater part of our misery or unhappiness is determined not by our circumstance but by our disposition. MARTHA WASHINGTON

Insurance policies are prohibitively expensive because so many people will not take out insurance when they are healthy so those who do buy insurance do not get the benefit of healthy people paying premiums but not receiving equal benefits.  The insurance company has to take in more money than they pay out so premiums are high if most members collect substantial benefits.  Time was insurance coverage was part of the cost of employment but the high cost of labor has caused employers to scale way back on how much of employee compensation was given in benefits rather than wages. 

To get universal health care somebody has to put up the money to pay the bills.  If it is government, there has to be an increased amount of tax money going for it, and the taxpayers are the ones who pay.  If it is the insurance company the premiums are likely to be so high that reasonably healthy people will not buy the insurance unless it is required by law.  If it is required, there goes our freedom that people died to buy for us.

I wish I could see a way to get all worthy people taken care of for medical care but I don't see a system better than what we have now.  It worked better when more people paid insurance premiums but that has changed with increasing wage pressure.  So far I don't see any prospects for something better than what we have now.  God bless.

Age 82, diagnosed RA 12/2001, married since 1952, 4 sons no daughters, 4 grandsons 1 granddaughter.  Doing well on Methotrexate and Remicade.

Thanks for taking the time to share your thoughts on health care.  My eye is still giving me problems so I won't post much right now, except to say our current system is not sustainable.

One area to look at is what are the outcomes for certain procedures -- are they worth the cost, money we can't afford to waste.  The article on the knee surgery discusses this subject.  Two studies have now reported that certain arthoscopic knee surgeries have no better outcome than doing physical therapy and taking meds.  Guess whose not too quick to accept these results -- ortho surgeons that can make as much as $436,000 a year.

There is waste in our current system, fraud (see post about medical providers that defraud the US government) -- health care reforms could address how to make our health care system more efficient, and the money saved could be directed to providing medical services.

Well, all for now, gonna take a break.  Hope you are well, and the RA behavin, take care.

Joy

   

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I have learned that the greater part of our misery or unhappiness is determined not by our circumstance but by our disposition. MARTHA WASHINGTON