Today, I came across this article that caught my eye. I think the reason it caught my eye is the heading "Primary doctors earn $2.7M less than specialists during career." I always knew primary care doctors earned less than specialists but this heading made me want to read more. In this article by James Gallagher from the Triangle Business Journal he quotes from a study produced by Duke University. With the recent healthcare reform package passed the need for primary care physicians increases in order to achieve the objectives of improved coordination of care and ultimately cost savings. However, with less than 5% of the graduating medical students going into primary care we are in for a very challenging situation for a couple of reasons.
- 1. First, as the article points out, physicians take on a large amount of debt to complete medical school and establish a medical practice. With a large amount of debt staring them in the eyes it is no wonder they do not go into primary care.
- 2. Second, even if we fixed the reimbursement amount for primary care to make an advantage to go into this type of practice we will have "turn-around" time for more students to seek primary care as a career path.
Most are entering medical schools today with the full intent of going to specialized care so we already have between 4 to 8 years before this trend could possible move to more students seeking primary care as a career path. However, why would a student want to enter primary care today? We still do not know the impact of healthcare reform. We are still unsure of the payment security of Medicare for physicians. Even if primary care doctors get an increase in payments from Medicare, continued Medicare cuts will not make anyone feel confident to pursue primary care. We have a problem and this article highlights a underlying issue that must be dealt with to truly deal with effective healthcare reform for the future.
Read more about the Duke Study.
Emergency room visits are going up. In fact, in a recent survey published in Health Leaders magazine and Thomson Reuters, it showed that between 2007 and 2009 emergent visit rates increased at more than 12% annually.
However, it is also important to note that in today's medical schools less than 5% of the graduating class are going into primary care. If we are going to expand coverage to an additional 30 million individuals, who is going to treat these patients? In simple economics we have a supply and demand situation.
With the recent bill that's currently being debated within the Senate, ultimately it comes down to providing a little over 30 million underinsured or uninsured people to have access to care. The problem with that is it still leaves between 11 and 15 million people not having care.
So, have we truly moved the needle in providing healthcare reform? I would say no. A couple of reasons for this:
By providing access to care for an additional 30 million people, no one has really thought about where are those people going to go in today's environment? The assumption is today that most of these people who are underinsured or uninsured seek care primarily in the emergency rooms. If now they are given access to care through primary care or traditional methods, currently we do not have enough primary care physicians to treat those already insured. Adding another 30 million people to that pool will surely overwhelm the primary care physicians.- With the reform bill that's being debated today, cuts are being made to the Medicare payment system, and when you do that more and more providers, especially primary care physicians, will no longer seek or treat Medicare patients. So we'll have an exit of the primary care physicians once this passes, and we already have a shortage of primary care physicians.
It's important to note that in medical schools today, only five percent of students go into primary care. The feeling is that once this reform bill is debated, and the final details are communicated, that number of 5% will go lower once people realize the magnitude of not only the patient volume but also the ability to make money on these patients will be minimal.