Thursday, September 27, 2007

Doctor Shortage, effect of culture - And Who Shall Care for the Sick?

I had a delightful lunch this week with Robert Gifford, M.D., former associate dean at the Yale Medical School and developer and former administrator of the general medical section at Yale. On a part-time basis, Bob now teaches medical students ethics and physical diagnosis, and serves on the medical school admissions committee.

In the course our conversation, Bob noted,

“There’s a sea change out there among medical students, and those applying for admission. More than half the applicants are women, a surprising number of the men
are foreign-borne, and essentially none of them want to go into primary care, preferring instead such specialties as dermatology, anesthesiology, and radiology, all of which offer a more balanced life style.”

Bob wasn’t complaining. He was observing. His observations bring up fundamental questions. How can the U.S. increase the supply of primary care physicians who, after all, care for most of the chronically ill?

Federal subsidies for medical school and post-graduate training? Forgiveness of debt? Increase in Medicare payments for primary care? Narrowing of pay schedules between primary care doctors and specialists? Replacement of doctors by physician assistants and nurse practitioners? Racheting up professional and monetary incentives to enter primary care? Increasing the respect and status for primary care specialists among medical school faculties?

If you have any ideas on how to solve or ease these problems or answer these questions, please comment. I have my own opinions, one of which is that managed care has alienated doctors and made the profession less desirable for ambitious young Americans.

For general background reading on this subject, I recommend Big Doctoring in America: Profiles in Primary Care, by Fitzhugh Mullan, MD. 2004, University of California Press; and for specific information on demand, supply, salaries, and recruiting incentives for primary care, see Merritt Hawkin,s & Associates Guide to Physician Recruiting, by James Merritt, Joseph Hawkins, and Phillip Miller, Practice Support Resources, Inc, 2007.

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