Those of you who have been faithfully but foolishly following my entries about the U.S. health care , know that one of my big concerns has been the shortage of primary care health care providers. In today’s New York Times, there is an excellent article that lays it all out. The article is entitled “Doctor shortage proves obstacle to Obama goals,” and was written by Robert Pear. The U.S. currently has about 90 primary care physicians for every 100,000 people (I don’t know what the number would be if the primary care nurses were thrown in too). I haven’t seen any data showing what that number should be ideally, but most experts agree that we are far short of even an adequate number.
Why don’t we have enough primary care providers?
One reason for the shortage of primary care physicians is that few physicians want to go into primary care: in 2007 only 17% of medical graduates said they intended to go into primary care. I would be very surprised if the percentage is any higher now. It seems that every medical student I see in my clinics intends to go into either dermatology or radiology. Why is that? It’s simple- $$$$$ + lifestyle. Specialists generally make much more money than primary care providers and most (not all) have easier jobs (I am a specialist and I am not afraid to say it- I hope my specialist friends who work really hard don’t read this). The immediate question is how to pay primary care providers more. The debate is framed nicely by Mr. Pear in his article. Specialists agree that primary care providers need to be paid more but the specialists don’t want that pay increase to come from their incomes. I’m sure it’s already an ugly debate and I predict it will get much uglier before the dust settles.
The bottom line
We desperately need many, many more primary care physicians, nurses, and whatever. It will take time- years and years to achieve the desired levels. We need to get started. It will cost some money but it will be worth it. With respect to the debate about shifting payments from specialists to primary care providers, I will offer no opinions except that I predict someday soon, primary care providers will be serving as “gatekeepers” for speciality care services. Assuming I am correct, specialists would be wise to remember that their livelihoods will to a great extent depend on referrals from primary care providers. Of course, another way to look at the issue is that the major cost reductions we need to achieve in our health care system, are less related to direct payments to physicians but rather for the unreasonably costly services physicians generate (e.g., procedures, medications). We would probably do better not to delude ourselves into thinking that speciality physician salaries are an important part of the astonishingly high U.S. health care costs relative to other civilized places around the world.
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- Controlling Health Care Costs