The Real Reasons We Have A Primary Care Physician Shortage

To understand the primary care physician shortage we must first recognize that it is not just a matter of recruiting more new physicians into this specialty, but also keeping the ones we have in the field. The American College of Physicians and the American Board of Internal Medicine have found that 9% of all internists certified between 1990 and 1995 are no longer working in that specialty today. Further they found that general internists are 4 times more likely to leave the field than subspecialists. Finally they found that general internists as a group were far less satisfied with their career than subspecialists or those who switched specialties.

Why is this? What has changed for the primary care physician who for years was the backbone of our entire healthcare system? ...A lot has changed.

1) The pay is low compared to specialists. There has always been a gap between the reimbursement for primary care physicians and specialists, but this gap has continued to widen. It has now gotten out of reach. Primary care physicians earn about one half of what subspecialists make.

2) Much of the work is not reimbursed. Family doctors are primarily paid for each visit by a patient to their office. But in a particular study of physicians who see 18 patients a day in their office, they also do the following unreimbursed work: make 24 phone calls to patients and physicians; write 12 drug prescriptions; read 20 lab reports; examine 14 consultation reports from specialists; review 11 medical imaging reports; and write 17 emails to doctors and patients.

3) Increasing demands, expectations and accountability from patients and the outside public. As I have said in a previous post, the relationship between the physician and patient has changed. Patients question their physician much more and expect more from them. Meanwhile under healthcare reform the primary care physician's role is being changed to take on more of what specialists have done and expanding the number of patients they are responsible for. To achieve this they are being required to delegate a lot of the direct patient interaction to physician extenders.

Although the new healthcare legislation includes financial incentives for primary care physicians and payments for preventive health programs, I am afraid that it does not go far enough. We need to ensure that we provide a financially adequate and professionally satisfying career path for tomorrow's (and today's) primary care physicians.

More on this later.

Mark Brodeur