The Shrinking of the Primary Care Physician

Primary care physicians are already in short supply in many parts of the country, and the passing of the landmark Health Care Reform bill that will bring them millions more newly insured patients in the next few years, promises even more of a strain. It is the primary care physician, who recommends their accommodation, and visits patients with Alzheimer’s, other forms of dementia and chronic diseases in assisted living and nursing care facilities.

The new law goes beyond offering coverage to the uninsured, with steps to improve the quality of care for the average person and help keep us well instead of today's seek-care-after-you're-sick culture. However, to take advantage, you will need a regular health provider.

Recently published reports predict a shortfall of roughly 40,000 primary care doctors over the next decade, a profession losing out to the better pay, better hours and higher profile of many other specialties. Provisions in the new law aim to start reversing that tide, from bonus payments for certain physicians to expanded community health centers that will pick up some of the slack.

The law offers incentives to encourage more people to enter medical professions, and a 10% Medicare pay boost for primary-care doctors.

Also at issue, is the need for affordable education for would-be primary care physicians. To cope with the growing shortage, federal officials are considering several proposals. One would increase affordable enrollment in medical schools and residency training programs. Another would encourage greater use of nurse practitioners and physician assistants. A third would expand the National Health Service Corps, which deploys doctors and nurses in rural areas and poor neighborhoods.

The U.S. has 352,908 primary-care doctors now, and the college association estimates that 45,000 more will be needed by 2020. However, the number of medical-school students entering family medicine fell more than a quarter between 2002 and 2007.

Senator Max Baucus, a Montana Democrat and chairperson of the Finance Committee, said, “Medicare payments were skewed against primary care doctors, the very ones needed to coordinate the care of older people with chronic conditions such as congestive heart failure, diabetes and Alzheimer’s disease.”

A number of new medical schools have opened around the country recently. As of last October, four new schools enrolled about 190 students, and 12 medical schools raised the enrollment of first-year students by a total of about 150 slots, according to the AAMC. Some 18,000 students entered U.S. medical schools in the fall of 2009, the AAMC says.

Medicare pays $9.1 billion a year to teaching hospitals, which goes toward resident salaries and direct teaching costs, as well as the higher operating costs associated with teaching hospitals, which tend to see the sickest and most costly patients.

Doctors' groups and medical schools had hoped that the new health-care law passed in March, would increase the number of funded residency slots, but such a provision did not make it into the final bill.

The residency is the minimum three-year period when medical-school graduates train in hospitals and clinics.

There are about 110,000 resident positions in the U.S., according to the AAMC. Teaching hospitals rely heavily on Medicare funding to pay for these slots. In 1997, Congress imposed a cap on funding for medical residencies, which hospitals say has increasingly hurt their ability to expand the number of positions.

One provision in the Health Care Reform bill attempts to address residencies. Since some residency slots go unfilled each year, the law will pool the funding for unused slots and redistribute it to other institutions, with the majority of these slots going to primary care or general-surgery residencies. The slot redistribution will create additional residencies, because previously unfilled positions will now be used, according to the Centers for Medicare and Medicaid Services.

It will probably take 10 years to even make a dent into the number of doctors that we need out there," said Atul Grover, the AAMC's chief advocacy officer.