Throughout the past several years, more medical school students are choosing to become specialists over generalists (also called primary care physicians, or PCPs for short). Generalists, or PCPs, are those who provide and manage general care for patients; someone you would see for general check-ups and have knowledge in every area. Specialists, on the other hand, focus only on one aspect of care, like cardiologists or dermatologists for instance. This trend is so serious that according to the Association of American Medical Colleges (AAMC), "The U.S. will face a shortage of more than 90,000 primary care physicians by 2020 and 130,000 by 2025." With the impending Affordable Care Act upon us, millions of previously uninsured citizens will now have access to healthcare requiring the need of more primary care physicians. However, it appears that there are some plans to try and limit the problem as much as possible.Benefits of primary care are not as advantageous as those for becoming a specialist
Currently, less than 25% of graduating medical school students express an interest in a generalist career, and that number is decreasing steadily. According to a Robert Graham Center study, the strongest negative predictor of primary career choice was expected income in primary care compared to that of specialty care, which cut the odds of choosing a primary care career in half. With the average debt of medical students in 2009 around $132,000, most students are deciding to make a decision that best fits their financial needs. Top ranked specialists can see annual salaries around $365,000 while primary care physicians bring home around $177,000 on average. The income gap between generalists and specialists has grown to nearly 3-fold, resulting in an income disparity of around $3.5 million throughout a 40 year career.
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| Students feel primary care work is more meaningful but also comes with more work and stress |
Lower quality of life, higher workload, lower prestige, and more stress, are other indirect factors as to why students are not choosing primary care positions. According to a study based on students' views on primary care, the current generation, "millenials", still aspire to excellence as older generations did, but they tend to not want to sacrifice quality of life for career growth.
Affordable Care Act will force us to need more generalists
The physician shortage for our country is going to be magnified for two main reasons: the baby boomer generation is growing older and the newly planned Affordable Care Act (ACA) will soon be implemented. As baby boomers grow older, the demand for physicians is going to increase due to a greater proportion of older people needing health care. As the Affordable Care Act gets implemented, an estimated 14 million previously uninsured people will now begin to seek care from an already depleted amount of physicians. Further adding to the problem is that nearly half of the country's 830,000 physicians are over the age of 50 and are seeing fewer patients then they were four years ago.
The new Act is getting some backlash from current physicians as well. Deloitte conducted a research study where 6 in 10 physicians said it is likely many doctors will retire earlier than planned in the next one to three years. Physicians are now being forced to see a larger number of patients and they feel their reimbursement rate isn't enough for the stark increase in workload.
Deborah Rivkin, Vice President of Government Affairs for CareFirst BlueCross BlueShield, discusses the implications of the ACA on a state like Maryland. She states that there seems to already be an issue with the amount of PCPs Maryland currently has and this is even before the introduction of millions into the system.
Citizens in southern, western, and eastern Maryland could be most affected because there is about to be a large influx of people into the system and these areas are already have a low amount of PCPs. Deborah goes on to mention how the ACA will create a "network" where other members of the health care system will start getting involved in order to combat some of the shortage we already face.
Plans are in place to try and fix the physician shortage in the future
As the baby boomers get older and the physician shortage continues, new solutions need to be developed in order to combat the growing problem. New research has indicated that new primary care models using nurse practitioners and physician assistants (PA's) could "eliminate" the scarcity of primary care doctors. In fact, researchers at the Rand Corp. estimate that an expansion of patient centered medical homes and nurse managed health centers could eliminate 50% or more of the primary care physician shortage in the U.S. by 2025. Most of these new models indicate that these nurse practitioners and PA's would reach out to patients, make sure they are taking their medications, and are adhering to doctor's orders. The American Academy of Physician Assistants is expecting 10,000 new PA's by 2020. By empowering nurse practitioners and PA's, they are able to provide some, if not most, of the same care that PCPs give to patients.
In a study done by the AAMC, medical schools are also doing their part by enrolling more students into medical programs as well as encouraging these students to pursue generalist careers. The AAMC had recommended a 30% increase in medical school enrollment by 2015, which would be an increase of about 4,946 students for a total of 21,434 students. The study shows that they will reach this 30% increase of first-year medical enrollment in 2017-2018 and that new schools will help with this large growth. Schools also stated that they either had or were planning at least one initiative to increase student interest in primary care and 38% of these schools will implement these changes in the next two years. These initiatives include changes in curriculum, extracurricular opportunities, or expanded faculty resources and training. Deborah offers her own thoughts as to what should be done based on what she experiences in her daily work.
Our country is clearly seeing an issue with the amount of students choosing to become primary care physicians. It is evident that there are some clear benefits for students deciding to specialize; higher pay, less workload, and to some extent, a higher prestige in the medical world. The Affordable Care Act will clearly pose an issue due to the fact we are going to see a mass influx of new citizens into the system, but there are at least some programs in place to try and curb the unfavorable trend. Deborah states that the "network" of people in the health care system will have to grow in order to take some of the workload off current physicians and that there should be some incentive programs for students in the future. It will be interesting to see how much of an effect this trend will have given what we know about the issue and the plans we have to try and fix it before it is too late.
