Doctors predict family physician shortage

[OhioChick]

By CARLA K. JOHNSON, Associated Press Writer
Wed Sep 27, 12:35 AM ET
CHICAGO - A doctors group expects a serious shortfall of family physicians in at least five states by 2020.

Population growth and rising numbers of elderly people in Nevada, Arizona, Florida, Texas and Idaho will make the need in those states most critical, said Dr. Perry Pugno of the American Academy of Family Physicians.

"As Americans age, they need more health-care interventions, and primary care is the most cost-effective way to help them maintain their health," Pugno said.

The number of U.S. medical graduates going into family medicine has been falling — by more than 50 percent from 1997 to 2005 — with many young doctors preferring specialties that pay better and offer more control over work hours.

http://news.yahoo.com/s/ap/20060927/ap_on_he_me/family_doctors

on edit: fix link

[pooja]

1. We need more holistic Dr.s and there would be less need for

so many trips to the Dr.s in the first place. Welcome to America: The richest sick people in the world.

[SharonAnn]

18. Medical schools and their slots have been artificially kept low so that

there wouldn't be a lglut of doctors. The AMA and associated organizations have tried to limit the number of seats for medical schools. While it's true that schools should be high-caliber which requires adequate funding, there could've been expansions and there weren't. Doctors were too worried about protecting their fees. That's why we've seen such an influx of foreign physicians. The demand is here but the schools are not.

So, we suffer from a shortage of family physicians because apparently the goal of going to medical school in this country is to become a rich specialist, not to practice medicine.

I'm from a family of physicians, going back a couple of generations, so I'm somehwat familiar with the artificial structures that have been perpetuated.

[NNguyenMD]

20. Osteopathic physician graduates attempt to fill this gap, better so than

their MD counterparts. An Osteopathic Physician is a doctor with a DO degree versus an MD. They go through the same schooling as MD docs, but they also train in OMM or Osteopathic Medicinal Manipulation I believe it called.

But anyway, I'm helping my friend apply for Osteopathic schools and learned that a very significant number, sometimes majority, of these graduates go in Familiy Medicine, and if not that then other primary care fields like Internal Medicine, Pediatrics, or Emergency Medicine.

I admire this a lot because on average, Osteopathic physicians have significantly higher debt than MD physicians, yet they are also going into fields that pay significantly less than specialists. They have more debt because their schools are private and need to charge a very high tuition to keep it running, their class sizes are also larger because of this and many of them need to contract with hospitals that are far away to send their students to do clerkships, versus traditional med schools that have their own on campus hospitals. And unlike the AMA (a club which I never intend to ever become a part of), the American Osteopathic Association is making a real effort to expand the number of schools and thus physician graduates. There is a new osteopathic school opening up in eastern Tennessee this year, and next year there will be two more, one which will be Harlem and one in east Washington state.

I am going into internal medicine, which is primary care, but I will probably subspecialize because I find inpatient (hospital work) much more interesting. Maybe later in my career I will slow down with a primary care office.

But just wanted to shed some light into DO's, and if there is anyone who is tackling this shortage head on, it is them.

[argyl]

26. My current family doctor is a DO, as was my previous physician. They are

indeed doing a large part in filling the shortage of family practitioners. Their level of care is excellent and generally I have found them to be quite compassionate.

Plus, if you have an episode of back spasms they can adjust your back and give a trigger point injection of cortisone and prescribe pain medication if necessary.

[saigon68]

19. That's OK I'm sure a few hundred thousand 5-B Visas will be arranged for

for Sanjay and his friends

[OhioChick]

23. OMG........LMAO here........

I know this is a serious situation, but your comment has me with tears in my eyes. (However, your statement holds truth)

[Vinca]

2. Finally - something I don't have to worry about.

No insurance, no doctor anyway.

[sam sarrha]

3. maybe Fidel can loan us some of his extra family medics

[Dick Diver]

9. Although I suspect...

you are being a bit tounge-in-cheek, something similar to this is happening. MDs from accredited foreign universities are able to practice in the US after going through various (depending upon the stage they're at in their profession) certifications by the AMA. For example, if the MD was in residency in their own country, he/she will normally be expected to complete a full residency in the US. However, the AMA is very protective about their specialties and these folk are normally restricted to becoming GPs. That's the direction the profession is going in, i.e. a growing percentage of "Family Doctors" are foreign-trained.

[Bacchus39]

11. they would certainly earn more than $20 a month

n/t

[Dick Diver]

I suspect...

they make signifcantly more than $20/month in real terms, i.e., once the perks are figured in as well as the cost of living in Cuba. The difficulty for them, of course, is that all those helpful perks won't buy you a plane ticket (even if you could, in Cuba). It's great to talk about how the state pays for (or subsidizes) my housing, food, transportation, etc. That is, if you're satisfied with living in the same place and never going anywhere your entire live, since you certainly won't be able to financially with the amount of hard cash you receive.

BTW, I think that if Fidel did loan us a few, he'd be hard pressed to convince them to come back. Once they started making $150k in Topeka, they might find the attractions of capitalism a bit difficult to foresake.

[Cobalt Violet]

4. How about importing them.

Don't we still have those cheap labor visas? Or is that only for some occupations?:sarcasm:

[midnight]

5. I went to meet with Brian Kennedy who is running against

Sennsenbrenner, and he said we needed more nurses, and not Doc's. Maybe those rural areas in Nevada ,AZ., Florida, Tx. Maybe nurse practitioners can provide this primary care. If that's alright with the AMA.

[SheilaT]

6. Every few years there are

reports of some kind of physician shortages. A few years ago all OBs were supposedly closing up shop. I guess women are now delivering their babies at home on a mass scale?

There long has been a lack of doctors in many rural areas, from what I understand.

I wonder if this shortage would be even worse if we had the kind of universal coverage almost every other country int he world has.

[leftyladyfrommo]

7. It's OK. Now we can all just go to Osco - they have little clinics in

the back of the stores - no doctors. But the nurses are probably better at what they do anyway.

[Dick Diver]

8. This problem is aggravated by...

not only the aging population, but the fact that doctors' salaries in general have either remained flat or declined in real terms since the 1980s in the US. Coupled with the fact that one must spend 4 years as an undergraduate, 4 years in medical school, and 4 years in residency to become a doctor, all the while accumulating loans that can, at the end of the cycle, amount to $250k+, makes the field much less attractive than it once was. And, after all that, to become a General Practioner and make in the range of $150k makes it a no-win proposition. Much better to spend a couple more years in residency and go into a specialty.

This is made worse by the impacts of medicare/medicaid driving down incomes. And, as one poster referenced rural areas, to be a GP in a such an area, makes virtually no financial sense, as doctors' earning potentials in those areas are significantly less than in the major metropolitan areas. FROM A FINANCIAL PERSPECTIVE, the smart money in the health professions now is in dentistry -- very little requirements (other than oral surgeons in ERs) to service non-paying clients.

[sam sarrha]

14. the problem is the cost of education.. under * it is unavaible mo most

[Dick Diver]

15. I think it's much more complex than that.

First, the cost of education has been rising steadily for the last 20 years, not just during the current administration. Second, the costs of running a medical school are tremendous, including equipment and faculty. Third, it's not only the financial costs that necessitate a higher compensation level for doctors, it's the cost in time. If I am going to spend 12 years of my life (minimum) training for a profession, I'm going to expect to be very well compensated for that. Otherwise, why bother?

[bleedingheart]

22. how about pursuing a profession because you want to do it

and because you can do something good?

If money is the only reason someone becomes a doctor...than well I don't know that I would want to go to that doctor.

I know a fellow who has a BS in electrical engineering, two masters degrees and a PhD...he has spent well more than 12 years of his life going to school...yet he isn't making anywhere near $150K a year...but he loves his work and he loves learning.

There are many reasons why people pursue higher education and not all of them are financial although being well compensated is a benefit.

[Dick Diver]

24. I'm glad for your friend...

I have two Bachelors degrees and two Masters. However, did your friend spend $40k-$60k per year in tuition, as is common in most medical schools today? If he did, then more power to him; if he didn't, then you should recognize that those who do, expect (and require) a higher return on their money.

[AnneD]

10. This is old news....

This storm has been brewing for some time, almost as long as the Nurse shortage. The reimbursements are greater for the specialties-which gives short shrift to the great body of knowledge one needs to know and keep updated on. It almost seems as if Nurse Practitioners are starting to fill the GP void.

[0007]

12. I first heard this rumor about fifty years ago

How come Cuba has no problem producing doctors? And they don't make half as much as a US croaker.

[Dick Diver]

13. I suspect they make significantly less than half as much...

even with the various "perks," i.e., housing supplements, etc. But the answer to your question is simple. It's one of the best (in financial terms) there is in Cuba. Doctors make more than most of the rest of the people and so, it's an attactive profession.

It's the same in various Eastern European countries. Doctors, for example, in Romania can make around $25,000 per year. The difference between Eastern Europe and Cuba, however, is that Eastern European doctors can now (since the fall of the Soviet Empire) leave and go to either Western Europe or the US and make a lot more. Hence, the growing shortage of doctors in Eastern Europe. Cuba's doctors don't exactly have that option; they are, shall we say, a "captive audience."

[liberalnurse]

16. The Family Nurse Practitioner

can fill the void.....

[Ramsey]

25. Maybe

But NPs don't have the same level of training as doctors, especially in diagnosis and physiology. NPs can do many small procedures and assess symptom,s but their diagnostic and disease management training is significantly less than a physician's. There is a reason it takes a minimum of 8 years of postgraduate training to become a licensed MD.

[hunter]

17. It's become a job like teaching. You don't do it for money or prestige...

The true horror of medicine in the United States is that it has been turned into an "industry" controlled mostly by the insurance and pharmaceutical corporations.

In effect we are now importing doctors just like we import farm workers and nurses because this leads to greater short term profits for the huge U.S. medical industry. In this business the average medical "consumer" is just a number, and if any doctor quits because working conditions are intolerable, this business will find someone else to fill that spot.

No matter how bad things get these big corporations will always have someone around they can call "doctor" even if you can't actually see the doctor, and even if the doctor practices little more than writing prescriptions for expensive drugs.

[kwassa]

21. The other big problem is ballooning malpractice insurance costs

Here in Maryland, physicians are getting squeezed between soaring malpractice premiums and declining payments on claims from insurance companies. Some have left medicine altogether. My family doctor sold his practice and bought into a practice in Idaho, because he couldn't make enough money here to send his kids to college. I also talked to a surgeon who said that there were about 25% unfilled surgical positions at a local prestigious hospital because they couldn't attract young surgeons with the high malpractice rates.

[Xithras]

27. It's insurance, HMO's, and medical loans. I wouldn't be a doctor nowadays

It costs roughly $250,000 to become a doctor nowadays. That may seem like a lot, but it really hasn't changed all that much over the past several decades (when indexed to inflation). The difference is that HMO's have effectively capped the income of doctors by putting them onto a set payment schedule. Couple that with massively increased insurance premiums, and we now have a situation where a student can spend 12 years in college, rack up $250k in debt, and then spend the next 20 years trying to pay that debt off. A student leaving high school today with a medical GP career planned may not actually make any real money for 30 years. If you were leaving high school, would you really want a career that wouldn't offer any financial benefit until you were 50?

The only way to avoid this is to specialize in something that the HMO's will pay more money for. OB, surgery, or any of the other myriad of specialty medical services have far higher HMO reimbursement rates, so medical students pursue those careers to pay off their loans faster. This leads to a glut of specialists, and a shortage of family GP's.

My own doctor once told me that for his practice to break even, he can spend no more than 20 minutes with a patient. If one patient requires more than 20 minutes to deal with, he has to "steal back" that time from other patients throughout the day. And that's just to keep his LIGHTS ON. When I asked why, his response was a flat "insurance and school loans". He should have them paid off in about another 10 years.

As to those who don't want doctors who are interested in money...well, I am interested in having decent doctors around. Like schoolteachers, you might have a few who truly excel at it because they love the profession, but the majority will simply trudge along and do their rote because the benefits are decent and the retirement plan is good. Of course, unlike teachers, doctors don't get pensions or paid vacations unless they save their own money for them. Without decent pay, you'll only end up with a very small number of truly passionate doctors who love to heal...and THEY will get burned out fairly quickly as their patient load explodes.