For Dr. Tom Marcellino, the idea of being a family practice physician is a romantic one.
Marcellino - the grandson of a longtime central Kansas family physician - likes the idea of having a core group of patients that he gets to know.
"You get to talk to people," said Marcellino, a new doctor with Lawrence's Mt. Oread Family Practice. "You see them for most of their lives. You see their children."
According to new data, though, romance is withering quickly these days in the medical profession. Survey results published Wednesday by a national medical journal found that only 2 percent of graduating medical students say they plan to work in the primary care internal medicine field. Instead, a large number of medical students say they plan to enter specialized fields of medicine that often pay more than what a general family practice doctor can make.
"I think this is a very concerning trend for health care in this country," Marcellino said.
He said the demand for family care physicians will increase as members of the baby boom generation age. He said family care doctors are a key cog in the nation's health care system because they are the managers of the many different health care needs that a patient may have.
But the survey - published in the Journal of the American Medical Association - found paperwork, the demands of the chronically sick and the need to bring work home are among the factors pushing young doctors away from careers in primary care.
"I didn't want to fight the insurance companies," said Dr. Jason Shipman, 36, a radiology resident at Vanderbilt University Medical Center in Nashville, Tenn., who is carrying $150,000 in student debt.
The salary gap may be another reason. Family medicine had the lowest average salary last year at $186,000. A specialist in orthopedic surgery, for example, earned $436,000 per year on average.
Meanwhile, medical school is getting more expensive. The average graduate last year had $140,000 in student debt, up nearly 8 percent from the previous year, according to the Association of American Medical Colleges.
Another likely factor: Medicare's fee schedule pays less for office visits than for simple procedures, according to the American College of Physicians, which began reporting in 2006 that the nation's primary care system is "at grave risk of collapse."
A separate study in the medical journal suggest graduates from international medical schools are filling the primary care gap. About 2,600 fewer U.S. doctors were training in the primary care field in 2007 compared to 2002. In the same span, the number of foreign graduates pursing those careers rose by nearly 3,300.
"Primary care is holding steady but only because of international medical school graduates," said Edward Salsberg of the Association of American Medical Colleges. "And holding steady in numbers is probably not sufficient when the population is growing and aging."
Marcellino said he thought one possible approach to reversing the trend was to make sure medical students understood the wide range of possibilities available to primary care doctors.
"I can go be a sports medicine doctor for a team, I can be a cruise ship doctor, I can do urgent care work, I can work in a small-town ER," Marcellino said. "There are so many different options that I wouldn't have if I just focused on one specialty."
Marcellino also said he thought Kansas might end up being a leader in solving the issue. Marcellino is a graduate of the Kansas University Medical School, where he went through the school's Wichita-based program. He said the medical school faculty in Wichita placed a heavy emphasis on practicing family medicine, especially in rural areas of the state.