The cure for a doctor shortage: primary care and teamwork
By 2025, the U.S. could face a shortage of as many as 90,000 physicians. That’s according to the latest report from the Association of American Medical Colleges. The lack of doctors – particularly primary care doctors – is a concern across the country, but it’s particularly severe in southern states. But filling the patient-doctor gap is not as simple as training more doctors.
In just a few years, new medical degree programs in North, Central and South Texas will all be open – adding hundreds of new doctors to a state with a severe shortage. Problem solved?
Not really, said Dennis Andrulis, with the Texas Health Institute. “Increasing the number of doctors, that term needs to be deconstructed."
The key isn’t how many doctors you churn out, it’s what kind. States like Texas, Andrulis said, need doctors who go into family practice and treat folks in underserved areas for chronic conditions like obesity and hypertension. But that isn’t where the money is.
“People come out [of medical school] with such debt that they are pushed into the allure of specialty surgery, spinal surgery, anesthesiologists, radiologists, […] because that’s where the big money is,” Andrulis said.
Last year, across the country, the average specialist earned $284,ooo, according to a Medscape physician compensation survey. The average primary care doc? $195,000. So, selling recent graduates on family practice isn’t easy. Even if there’s a lifetime supply of free lollipops.
Dr. Matthew Simon has been a pediatrician in Dallas for four years. He went to medical school in state and did his residency in Dallas. And get this: he’s working in the very same office he used to visit for his own checkups when he was a kid.
Dr. Matt Simon and patient Jeremy Thomas. Simon chose to become a pediatrician, working in the same office he used to visit as a child.
“There’s no pediatrician I know of that’s going hungry or doesn’t have a home,” Simon said. “But financially taking this job was not the right decision at all, but it’s a decision that’s proved fruitful in other ways.”
This afternoon he’s talking with patient Jeremy Thomas about vaccines and exercise. At 22, this will be Thomas’s last visit with Dr. Simon and they’re both a bit nostalgic. Simon said yes, he liked the adrenaline of working in the ER and the possibility of receiving higher paychecks as a specialist, but this gives him a chance to create long-lasting relationships with patients.
“That’s what I enjoyed about it,” Simon said. “It’s not always a glamorous positions, but it is one of the most important ones.”
That's especially true as health care shifts to a focus on prevention. Linda Green, a professor of health care management at the Columbia Business School, said higher reimbursements for primary care docs could help recruit future graduates, but there’s a more immediate fix to the doctor shortage – it’s called teamwork.
“Allowing nurse practitioners to practice the full scope of their abilities,” Green said. “There are a bunch of states that don’t allow that.”
More states are allowing nurse practitioners to treat things like flu and strep throat so primary care doctors can take on more patients. Add to that idea doctors working in small group practices instead of on their own, and Green said you could significantly reduce the shortage.
“And it’s better for the physicians,” she said. “They have someone who backs them up who knows their patients, and particularly in this day and age when we have more electronic medical records the other physician can easily see the medical history of the patient and what’s been going on.”
If patients expect to see a doctor in a timely fashion, Green said we’ll need to rely on more primary care training, better technology and teamwork.