Last year, America spent over $2 trillion on health care, the most of any OECD country. Still, with all that money going out the door there is a worsening income crisis among primary-care physicians that, if unaddressed, will lead to an acute shortage of these doctors in the years ahead, when retiring baby boomers will need them most.
The education pipeline offers no hint of improvement. Less than 2% of current medical students are interested in general internal medicine and 4.9% in family-care practice, says a study by Dr. Karen Hauer, published in the Journal of the American Medical Association.
While a growing concern, it's no mystery as to why the general practitioner (GP) is a dying breed. Rising medical-school costs up between 4% and 7% from last year, according to American Association of Medical Colleges (AAMC) data and a continually widening gap between general-practitioner and specialist salaries make the career choice for medical students a fairly easy one: get a specialty.
"Primary care, especially family medicine, was what I wanted to do when I started medical school. Now three years later with $150,000 in debt, I am considering specializing in neurology," says Samantha Luk, a third-year medical-school student at Northwestern University. While she hasn't ruled out family medicine when she has to make her career decision in 2011, the combination of a higher salary and more interesting work that neurology offers is swaying her to specialize.
In 2009, primary-care doctors earned a median salary of $191,401, according to the Medical Group Management Association's 2010 physician-compensation report. Cardiologists earned a median of $457,310 and dermatologists made $385,088 doctors who owned their practices earned much more, on average.
In these tough economic times, most Americans would say that any of those incomes seem high. In fact, the primary-care doctor's gross is often far short of what they need to make ends meet. The average medical-school student graduates with $200,000 in loans, according to the American Academy of Family Physicians (AAFP). This doesn't include their debt related to four years of undergraduate study. For some students the total debt burden can reach nearly $500,000 a daunting sum that puts many of them off family medicine. "Money is a bigger influence on these decisions than most students will admit," Luk says. Plus, specialties offer lifestyle advantages, like more time with family in the long run.
Even for students without heavy debt burdens, the appeal of a general practice is low. "I don't believe medical students go into this profession to make money," says Jamil Ortoleva, a third-year medical student at Columbia University. "But family physicians don't make enough to cover costs of running a clinic, the insurance is high and so many clinics have closed over the past few years. Even GPs still in business have to take on more patients to pay the bills. The quality of care goes down, and that's a huge deterrent," he adds.
The trend away from family practice is already producing shortages in rural areas and could produce a national doctor crisis in just a few years. "Unless more primary-care physicians are recruited, we estimate a shortage of 30,000 doctors by 2015," says Dr. Atul Grover, chief advocacy officer for the AAMC. "In 10 years, this shortage could go up to 150,000. It takes seven years to train a doctor, so we need to act now," he says.
The recent passage of health care reform legislation offers some improvement to primary-care doctors, but doctors see it as insufficient. "The new legislation adds a 10% bonus to primary-care physicians' Medicare reimbursement salaries. But this is nowhere near enough. We need to see a 30% to 50% increase in salaries overall to make any real change in the system," says Dr. Lori Heim, president of the AAFP.