There are plenty of things in short supply in America these days: jobs, pay phones, reasonably priced gas. But would you think that there's also a shortage of primary care physicians?
According to the Archives of Internal Medicine, 9 percent of 2,000 medical school seniors surveyed in 1990 said they planned to go into internal medicine; by 2007, that number had dropped to fewer than 2 percent. Why? Money. That's a big part of it, at least. Primary care physicians make in the neighborhood of $176,000 a year--a more than respectable wage, until you consider that the average graduating physician leaves med school with $150,000 in loans. Suddenly, a career as a cardiologist (who, on average, makes more than twice what a primary care physician does) or a neurosurgeon (who can make more than three times) starts to seem like a tempting alternative.
If the survey is an accurate predictor, then America can expect to gain less than a thousand new primary care physicians over the next three years. An extreme prediction? Probably. Especially since the Obama administration recently invested $250 million to help strengthen the country's primary care workforce. Still, there's no disputing that, come 2014, when mandatory nationwide health care goes into effect, we are going to be very short on the number of primary care physicians we'll need to care for 46 million new patients.
(UPDATE: In April 2012, a survey of nearly 500 doctors revealed that a majority of young doctors are pessimistic about the future of the U.S. healthcare system, citing the new healthcare law as the primary concern.)
What does this shortage mean for you?
1 Much longer wait times to see your doctor, for one.
2 If you don't have a primary care doctor now, good luck getting one then.
3 An increased reliance on emergency rooms for non-emergency needs (and we all know how misguided and expensive those visits can be).
For a current picture of this shortage, we have Massachusetts, which mandated universal coverage in 2006, and which has already shown spikes in the above trends. And the ratio of primary care physicians to the population is much higher there than in other states. Imagine how long the waiting times for doctor appointments in states with low doctor populations, like Alaska and Wyoming, could be when 2014 rolls around? This website takes a look at how severe the doctor shortage in your state may become.
As a doctor myself, I can lament the shortage of primary care physicians in the U.S. And I do. But having had to adapt to all sorts of other changes in health care over the course of my career--and amazed by so much of the Internet technology I've seen--I'm also optimistic that telemedicine can offer alternatives to a patient who is told that the doctor is not in--or at least not able to see her for four or five weeks. Like it or not, we are all going to have to negotiate the primary care physician shortage in America, and turning to our laptops or our smartphones--in some select cases--might actually be a very wise place to start.
Mark L. Friedman MD FACEP FACP is an emergency physician working to revolutionize the delivery of health care.