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The Crisis in Primary Health Care

A Complete Examination

The shortage of primary-care doctors is growing worse. Alternatives exist, but they have flaws and might even contribute further to the shortage.

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Lou Turner, who is a retired high-school physics teacher, has gone through four primary-care doctors since he relocated to Cape Cod, Mass., 10 years ago. In one case, his doctor shut down his practice to pursue a career in dermatology. “I had him for at least a year, maybe two, and he evidently wasn’t making enough money as a primary-care doctor, so he stopped taking patients,” Turner says.

Predicaments such as Turner’s are, unfortunately, all too common, and that’s assuming that you even can find a primary-care doctor: You might be one of 65 million Americans who live in an area that doesn’t have enough primary-care coverage, according to Health Resources and Services Administration. And finding time with a primary-care doctor could become even more difficult when a projected 30 million newly insured patients enter the market by 2019, thanks to the 2010 Affordable Care Act, which will require most Americans to obtain health-insurance coverage or pay a fine. And that means that the quality of the care that you receive might suffer.

But possible solutions to the shortage of primary-care doctors have shortcomings. Whether such options are right for you depends on where you live, how much that you want to spend and, ultimately, your health-care needs.

SHOW ME THE MONEY. Even before health-care reform was enacted, Congressional Budget Office projected patient demand to jump, as Baby Boomers reach the age where regular primary care is needed to manage chronic conditions, such as coronary artery disease, diabetes and congestive heart failure. But the problem isn’t only too many patients but also too few doctors.

The number of U.S. medical graduates who enter residency training for family practice and internal medicine—the two specialties that are at the core of the primary-care workforce—is sobering. According to American College of Physicians, from 1997 to 2005, the number of graduates who became primary-care doctors—those who practice family medicine or internal medicine—dropped by 50 percent. By 2007, only 2 percent of fourth-year medical students planned to have a career in internal medicine. By 2020, the United States will face a shortfall of 45,000 primary-care doctors, Association of American Medical Colleges (AAMC) says.

Ask almost any primary-care doctor and he/she will point to the same problem: money. Doctors make more money if they specialize. For example, Turner’s doctor-turned-dermatologist stands to make an average of $314,000 annually, compared with a $175,000 average as a primary-care doctor, according to recruiting company Merritt Hawkins & Associates. Although salary certainly isn’t the only consideration in choosing to pursue a specialty, it plays a large role, partly because about one-quarter of all medical students graduate more than $200,000 in debt. (Dermatology also is considered to be less stressful and less unpredictable.)

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More than just money and stress levels are affecting doctors’ move away from primary care. More-complex government regulations and insurance requirements cause doctors to spend more time on paperwork, and the more time that a doctor spends on paperwork, the less time that he/she has to devote to patients.

GO WITH THE ‘O’? The shortage of primary-care doctors likely would be worse than it is if not for two groups of doctors: international medical graduates (IMGs) and doctors of osteopathy (D.O.). From 1995 to 2006, the number of medical-doctor (M.D.) graduates who were in primary-care residencies dropped by 1,655. During the same period, the number of IMGs who were in primary-care residencies rose by 2,540, and the number of osteopaths increased by 1,415, according to Government Accountability Office (GAO).

Osteopathic medical-school enrollment has increased steadily by 6 percent to 8 percent per year, according to American Osteopathic Association (AOA). As the number of D.O. graduates increases, osteopaths likely will play a bigger role in the health-care system in coming years. AOA estimates that by 2020 more than 100,000 osteopaths will practice medicine, up from 70,480 in 2010.

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