Archive for Thursday, September 11, 2008

Care crisis: Only 2 percent of med students plan to work in primary care field

Many factors, including salary, deplete ranks of family doctors

Dr. Tom Marcellino takes a look at the injured heel of Eudora resident Craig Potthast on Wednesday at Mt. Oread Family Practice. Marcellino is among the dwindling number of recent medical school graduates to enter the field of family care. Most young doctors are opting for specialized and higher-paying practices.

Dr. Tom Marcellino takes a look at the injured heel of Eudora resident Craig Potthast on Wednesday at Mt. Oread Family Practice. Marcellino is among the dwindling number of recent medical school graduates to enter the field of family care. Most young doctors are opting for specialized and higher-paying practices.

September 11, 2008

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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.

The Associated Press contributed information to this report.

Comments

just_another_bozo_on_this_bus 6 years, 7 months ago

Malpractice suit payouts only account for 2% of overall medical expenditures, so the high cost of malpractice insurance has another cause-- namely, profiteering by insurance companies.

sourpuss 6 years, 7 months ago

You mean 98% of the people who become doctors do so for the MONEY, and not an overwhelming desire to help others? Good god, I don't believe it! There is a reason why the AMA fights so hard against national health care... it would make medical care more affordable and specialists less rich.

Kam_Fong_as_Chin_Ho 6 years, 7 months ago

"You mean 98% of the people who become doctors do so for the MONEY, and not an overwhelming desire to help others? Good god, I don't believe it!"People have every right to seek a lucrative career. When you serve up Chicken McNuggets and fries to your customers, do you do it for the paycheck or is it because you have an overwhelming desire to feed the hungry?

texburgh 6 years, 7 months ago

"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."Let me see if I have this right:The three complaints: "paperwork" the same complaint teachers have."the need to bring work home" like lesson planning, grading assignments, and contacting parents."the demands of the chronically sick" very similar to the demands of under-achieving students or over-demanding parents. Dr. Shipman is carrying $150,000 in student debt but the average salary is $186,000. Dr. Shipman could pay off his entire debt in one year and still have $36,000 a typical annual salary for a starting teacher in an urban or large suburban school district. Well, I'm not a teacher, just a parent, but the plight of the family practice physician as described in this article does not bring me to tears of sympathy.

Haiku_Cuckoo 6 years, 7 months ago

"You mean 98% of the people who become doctors do so for the MONEY, and not an overwhelming desire to help others? Good god, I don't believe it!"Considering the litigious nature of this country, many doctors seek high paying positions to cover the cost of their insurance premiums. If people weren't so quick to file lawsuits, there would be a lot more doctors filling the lower paying MD positions.

akt2 6 years, 7 months ago

If you find yourself in the ER and need to be admitted, chances are you will not see your Primary Care Physician. There is a new category of physicians called Hospitalists. They admit, treat and discharge a patient back to their PCP. There are few family care doctors that still make hospital rounds.

lagreius 6 years, 7 months ago

Interest in concierge medicine is rapidly growing as a way of increasing student interest in entering primary care. Starting with the first such practice about twelve years ago in Seattle and growing exponentially, there are now thousands of such practices in the USA, some are associated with franchises though most are independent. A national society of concierge doctors and other direct practice doctors has existed since 2003 called The Society for Innovative Medical Practice Design, or SIMPD for short. Direct practice doctors and those who wish to adopt the direct practice model can join the society and get many benefits including up to 55% discounts on malpractice insurance, practice marketing help, national care networks and many other services. Patients can go to SIMPD's web site at http://www.simpd.org for information and to find such a doctor in their own community. This is the ideal way for patients to get personalized, prompt, excellent primary medical care in a unhurried, pleasant setting. Money is actually saved on patients in such practices because ER visits and hospitalizations are drastically reduced by the personalized, immediate, detailed care. SIMPD believes most Americans can eventually be cared for in such practices resulting in better care, lower cost and a return of interest in primary care by students who now shun the field as undervalued, underpaid and undesirable compared with other medical specialties.Thomas W. LaGrelius, MD, FAAFPPresident, SIMPD http://www.simpd.orgOwner, SPFC Torrance, CA http://www.skyparkpfc.com

easmith14 6 years, 7 months ago

Doctor, I have an illness, and the only cure is more Lawhorn.

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