Archive for Thursday, May 27, 1993


May 27, 1993


Primary care physicians in Lawrence and at Kansas University Medical Center agree their speciality will be facing a crisis if more medical students aren't encouraged to enter the general practice field.

"The problem is fairly simple," said Dr. Steve Bruner, family physician with the Lawrence Family Practice Center, 500 Rockledge. "For years and years and years general medicine practitioners have had to struggle with the fact that they don't get paid as much as specialists for working harder."

Health economists say a medical system should have about 50 percent of its doctors practicing primary care, which includes family practice, internal medicine and pediatrics, and that is the mix now favored by most large health maintenance organizations.

But the current percentage of primary care physicians in the country is only about 33 percent, and, worse, it's falling, reports the New York Times.

In 1992, only 14.6 percent of medical students decided to go into general medicine. At that rate, the proportion of primary care physicians will drop to 28 percent or less by 2010.

Lawrence Memorial Hospital is studying physician recruitment. So far, the study has revealed that for family practitioners and internists, there was the right number in Lawrence to serve the community, said Janice Early-Weas, director of community relations at LMH.

"We don't foresee a shortage until the year 2000," Early-Weas said.

LMH has 21 family practice physicians, 16 physicians in internal medicine and four pediatricians on its 79-member active staff.

Bruner said changes within the nation's medical schools are essential if the slide away from general practice is to be stopped.

Dr. Jane Murray, chair of the department of family practice at the KU Medical Center, said Kansas needs primary care physicians, and believes the medical schools are the places that must change to meet that need.

"It's interesting," she said. "There are several points at which career decisions get made by medical students. And while in school they are pushed toward specialties."

Also while those students are in school, their role models and instructors are surgeons and specialists, not primary care physicians.

"Medical schools have specialists on their faculty, not a large number of generalists, so the students get exposed from day one to an opinion of medicine that focuses on specialties," she said.

Another problem is the location of medical schools. Most are in hospital settings, where specialized care such as burn centers and neurology departments are the focus.

"Students get exposed to high-tech health care delivery," Murray said. "And that's what they decide they want to work with. Medical schools need to get more students out into primary care physicians' offices and other centers where generalists work."

But the main obstacle keeping medical students from general practice is simple economics. When the students leave college they usually take with them huge debts and loans. And they want to get that paid off.

"Eventually practicality begins to overwhelm the idealism of medical students," Bruner said. "The cost of medical school has risen and students are realizing they are going to graduate with high loan balances and high debt balances and the money is not in general medicine right now."

Bruner said even he notices the economic difference. He does Caesarean sections and earns about $1,400 for each one.

"It would take me at least two days to make that much in the office," Bruner said.

Lorene Valentine, director of rural health education and services with the KU School of Medicine, said the school is working on providing primary care physicians, especially for rural areas of Kansas.

One step in the right direction is the Kansas Bridging Plan, Valentine said.

"This program provides loans to students about to enter their medical residencies and are willing to practice in a rural area for at least three years," Valentine said. "They'll enter into the plan and receive some money over a two-year period during their residency and then they'll go practice in the rural community."

The medical school also has a "tele-medicine" program, which uses interactive video to link rural physicians with the KU Medical Center campuses in Kansas City and Wichita.

"It can be used for consultations, meetings and education," Valentine said. "And it helps relieve feelings of isolation."

Another program, Med-LINK, connects 12 rural sites to the medical library by computer, and will allow physicians to do searches and receive articles without leaving their offices.

But change in any field takes time, especially in medicine.

"Even if they did everything right, right now, it will still be a decade before the problem is fixed," Bruner said.

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