Primary care "shortage"

[DaWeasel]

Why is primary care such a major focus for many schools? In particular, the focus on rural communities? I don't get why this is such a big issue.

I don't understand why the focus is on pushing more physicians into rural areas? If it were a better option, there would be more in rural areas. And if it is such a pressing issue, why are primary care physicians among the least compensated?

I just write this as I'm looking through MSAR and seeing how many schools seem to put a major focus on primary care relative to other aspects of medicine. I myself am from a rural area, so I'm not talking negatively here. There just seems to be an economic disconnect when one of the least compensated areas of medicine is apparently considered so important to most schools.

---

Members don't see this ad.

 

[Officer Farva]

Why is primary care such a major focus for many schools? In particular, the focus on rural communities? I don't get why this is such a big issue.

I don't understand why the focus is on pushing more physicians into rural areas? If it were a better option, there would be more in rural areas. And if it is such a pressing issue, why are primary care physicians among the least compensated?

I just write this as I'm looking through MSAR and seeing how many schools seem to put a major focus on primary care relative to other aspects of medicine. I myself am from a rural area, so I'm not talking negatively here. There just seems to be an economic disconnect when one of the least compensated areas of medicine is apparently considered so important to most schools.

Probably a push from state governments. They have to support primary care to fulfill the needs of funding or something.

 

[FumblyBumbly]

There's a nice documentary on Netflix called Remote Area Medical that kind of illustrates the somewhat drastic need for more doctors in rural areas.

Also, I'm pretty sure the compensation/perks/loan-forgiveness/incentives for primary doctors willing to work in rural areas is quite nice. I don't think it's the compensation that leads to less doctors practicing in rural areas. It's the lifestyle. As someone who has lived in both rural and urban areas, I can tell you that the lifestyles are drastically different and if you grew up in one environment, you might have some trouble living in the other.

Which brings me to my next point. Given that population density is highest in urban areas, statistically there will be a much larger percentage of people in medical school that are from urban areas as opposed to rural areas. Most people go with what they know and so, most of these urban grads will go on to work in urban areas. Statistically, there won't be enough people originally from rural areas applying to medical school so schools are more proactive in recruiting such applicants than they are urban applicants.

I think the primary care doctors that are among the least compensated mainly work in urban areas where they are somewhat saturated. I think there are financial incentives for doctors working in under-served urban areas as well.

 

[gyngyn]

Medical schools are here for the people their graduates will eventually serve. We have no control over the pay that physicians receive but the least we can do is try to find people actually committed to service where service is needed.

 

[Goro]

This is something you will need to understand if you want to go to med school.

Why is primary care such a major focus for many schools? In particular, the focus on rural communities? I don't get why this is such a big issue.

I don't understand why the focus is on pushing more physicians into rural areas? If it were a better option, there would be more in rural areas. And if it is such a pressing issue, why are primary care physicians among the least compensated?

I just write this as I'm looking through MSAR and seeing how many schools seem to put a major focus on primary care relative to other aspects of medicine. I myself am from a rural area, so I'm not talking negatively here. There just seems to be an economic disconnect when one of the least compensated areas of medicine is apparently considered so important to most schools.

 

[DaWeasel]

I'm not really focused on the compensation aspect. My question is how did this become an issue, or has it always been? I brought up compensation as a mechanism for allocating doctors in a more desirable way. I'm just trying to get at the nature of the problem and solutions to it.

This is something you will need to understand if you want to go to med school.

I realize this. I am concerned with correcting the situation and I'd love to hear from people more informed about the nature of the issue in primary care. I want to actually be able to discuss the issue and not just reciprocate that it's important because everyone else says it is.

There's a nice documentary on Netflix called Remote Area Medical that kind of illustrates the somewhat drastic need for more doctors in rural areas.

Also, I'm pretty sure the compensation/perks/loan-forgiveness/incentives for primary doctors willing to work in rural areas is quite nice. I don't think it's the compensation that leads to less doctors practicing in rural areas. It's the lifestyle. As someone who has lived in both rural and urban areas, I can tell you that the lifestyles are drastically different and if you grew up in one environment, you might have some trouble living in the other.

Which brings me to my next point. Given that population density is highest in urban areas, statistically there will be a much larger percentage of people in medical school that are from urban areas as opposed to rural areas. Most people go with what they know and so, most of these urban grads will go on to work in urban areas. Statistically, there won't be enough people originally from rural areas applying to medical school so schools are more proactive in recruiting such applicants than they are urban applicants.

I think the primary care doctors that are among the least compensated mainly work in urban areas where they are somewhat saturated. I think there are financial incentives for doctors working in under-served urban areas as well.

From looking around online, it does appear that primary care doctors are more highly paid in rural areas, which definitely makes sense. As far as population density, while there may be a lower concentration of people in urban areas there will be correspondingly less people to serve. If people from both urban and rural areas return to the same types of areas at the same rates, where does the problem arise?

 

[FumblyBumbly]

From looking around online, it does appear that primary care doctors are more highly paid in rural areas, which definitely makes sense. As far as population density, while there may be a lower concentration of people in urban areas there will be correspondingly less people to serve. If people from both urban and rural areas return to the same types of areas at the same rates, where does the problem arise?

I think people don't return to the same types of areas at the same rates but for this example, assuming that they do return at the same rates, rural areas generally will still be under-served simply because of population density.

Say 1 out of every 5000 people become doctors. Denver has a population of about 650,000 people so every year, they get about 130 doctors in return for their population. Say there are 5 hypothetical small rural towns with populations that number 5000, 3000, 1300, 500, and 200. The combination of those 5 small towns is 10,000 so they get 2 doctors in return for their populations. Town 1 gets one doctor and Towns 2-5 get 1 doctor.

The nature of rural areas is that there's more land than people. Towns tend to be located long distances from each other. Say Towns 2-5 are situated in a straight line, each 20 miles away from each other. Doctor 2 now has the unenviable position of needing to travel 120 miles round trip to get from Town 2 to Town 5. This is kind of why rural areas need more doctors than their population would seem to demand.

Please note that this is all a very simplified view of the problem of rural doctors. I'm sure there are many more nuances that surround the issue and that I've not presented a completely true representation of the complex situation.

 

[DaWeasel]

I think people don't return to the same types of areas at the same rates but for this example, assuming that they do return at the same rates, rural areas generally will still be under-served simply because of population density.

Say 1 out of every 5000 people become doctors. Denver has a population of about 650,000 people so every year, they get about 130 doctors in return for their population. Say there are 5 hypothetical small rural towns with populations that number 5000, 3000, 1300, 500, and 200. The combination of those 5 small towns is 10,000 so they get 2 doctors in return for their populations. Town 1 gets one doctor and Towns 2-5 get 1 doctor.

The nature of rural areas is that there's more land than people. Towns tend to be located long distances from each other. Say Towns 2-5 are situated in a straight line, each 20 miles away from each other. Doctor 2 now has the unenviable position of needing to travel 120 miles round trip to get from Town 2 to Town 5. This is kind of why rural areas need more doctors than their population would seem to demand.

Please note that this is all a very simplified view of the problem of rural doctors. I'm sure there are many more nuances that surround the issue and that I've not presented a completely true representation of the complex situation.

Alright, I understand that point. But this seems to highlight the inefficiency of small rural towns. If you need more doctors, the most straight forward path seems to be to increase the compensation. The level of compensation can't rise above what the local population can support. I'm can understand there's a shortage, but I don't see any easy solution is my point

 

[FumblyBumbly]

Alright, I understand that point. But this seems to highlight the inefficiency of small rural towns. If you need more doctors, the most straight forward path seems to be to increase the compensation. The level of compensation can't rise above what the local population can support. I'm can understand there's a shortage, but I don't see any easy solution is my point

I agree that there's no easy solution and I actually doubt that we will ever truly solve this problem to any satisfaction in my lifetime. I'm just trying to explain the current state of things with a simplified model.

And I believe they are implementing the most straightforward path that you mentioned. There's a crap-ton of financial incentives for rural primary care doctors that are not available to urban primary care doctors. And as you've said, the internet reports that there is higher compensation for rural primary care doctors as opposed to urban primary care doctors.

 

[DaWeasel]

I agree that there's no easy solution and I actually doubt that we will ever truly solve this problem to any satisfaction in my lifetime. I'm just trying to explain the current state of things with a simplified model.

And I believe they are implementing the most straightforward path that you mentioned. There's a crap-ton of financial incentives for rural primary care doctors that are not available to urban primary care doctors. And as you've said, the internet reports that there is higher compensation for rural primary care doctors as opposed to urban primary care doctors.

Definitely a problem with no good solution. I feel like my original question here was misinterpreted as negative to primary care. I was just asking about the projected shortage and why it was that way. I understand how important the service aspect of medicine is. I'm only concerned with finding ways to improve the system to better help those in need.

 

[avgn]

It's funny. It's like you discovered North America for the first time like Columbus

1. Compensation has always been based on volume of procedures, not prevention or counseling or time spent with patients. PC thus gets **** pay
2. For many people, no amount of money is enough to incentivize them to live and practice in bumble****
3. The specialties that have been historically compensated well have a deep deep vested interest in keeping it that way and have generally succeeded in doing so
4. Complex institutional systems are slow to change
5. To point out it's illogical for PC to be paid poorly when it's very important is like pointing out the low pay of public school teachers when they are extremely important. The world is illogical like that, you are not the crazy one, med schools are not lying when they say PC is important

 

[qwerty89]

Another factor is that back in the day most docs were male and their spouse stayed at home and basically followed their husband wherever he got a job.

Nowadays you have way more 2 income households and people tend to marry within their socioeconomic background. More and more docs are marrying a spouse who has a high-end career themselves (i.e. Engineering, medicine, pharm, dent, business, etc). Hard to work in bumblef*** nowhere when your spouse works consulting and can't work in rural WI,IA,etc.

 

[DaWeasel]

It's funny. It's like you discovered North America for the first time like Columbus

1. Compensation has always been based on volume of procedures, not prevention or counseling or time spent with patients. PC thus gets **** pay
2. For many people, no amount of money is enough to incentivize them to live and practice in bumble****
3. The specialties that have been historically compensated well have a deep deep vested interest in keeping it that way and have generally succeeded in doing so
4. Complex institutional systems are slow to change
5. To point out it's illogical for PC to be paid poorly when it's very important is like pointing out the low pay of public school teachers when they are extremely important. The world is illogical like that, you are not the crazy one, med schools are not lying when they say PC is important

Yeah maybe I don't know anything at all, which is why I phrased the whole thing as a question. I'm from a very rural area, and I promise there aren't people dying in the streets out here. My whole question was just focused on why the big emphasis on entering something where the incentive structure is so poor? I definitely agree with 3 and 4. I don't think any shortage has to do with a lack of talent.

 

[FindMeOnTheLinks]

Many doctors are willing to accept less compensation if it means they can live in a larger city. When many people become doctors they are so fricken tired of all the work they have put into training, that they don't want to go live in a town of 1000 people with two grocery stores, 3 bars and a couple gas stations. They want to live in that fancy house with their fancy cars and go eat at fancy restaurants, and actually have the time to do that as well. To live in a small town likely means your shopping/dining/entertainment options are limited. And being the only physician in town means you are literally on call 24/7. After training, doctors just want to be able to enjoy themselves for the most part when their working hours are done for the day. That's why so few of them serve rural populations, even if they had the intentions of doing so when they first started training.

How to fix the problem? No clue, but here are a few ideas to start. Guarantee/expand loan forgiveness after X years of service to rural populations. These programs already exist in some capacity but there is no guarantee they will still be around the future. If you guarantee if, there's less risk for somebody to take on the offer.

There's probly other stuff you could do but it's midnight and I'm behind on lectures.

(For the record I absolutely do not mean to disparage rural locations as that is where I was brought up and intend to return after training. Just trying to provide some reasoning)

 

[Law2Doc]

First, there isn't a "shortage", but a maldistribution. The words matter a lot because how you address these problems is very different.

Second, it appears that most professionally educated people don't want to go work in underserved rural areas. People have tried a variety of approaches to sweeten the pot to no avail. and this is not a new problem, but with the aging of the baby boomer generation it is becoming a bigger problem.

There's no easy fix. Some form of loan forgiveness, high pay and mortgage assistance might be the best you can do, but these areas are partly underserved because they aren't cash rich. At the same time actively recruiting and giving preference to med school applicants with rural roots probably helps too.

 

[21Rush12]

There's a nice documentary on Netflix called Remote Area Medical that kind of illustrates the somewhat drastic need for more doctors in rural areas.

Thank you for this suggestion...I just watched it and it definitely offers a perspective and some measure of the scale of the problem.

 

[DaWeasel]

Many doctors are willing to accept less compensation if it means they can live in a larger city. When many people become doctors they are so fricken tired of all the work they have put into training, that they don't want to go live in a town of 1000 people with two grocery stores, 3 bars and a couple gas stations. They want to live in that fancy house with their fancy cars and go eat at fancy restaurants, and actually have the time to do that as well. To live in a small town likely means your shopping/dining/entertainment options are limited. And being the only physician in town means you are literally on call 24/7. After training, doctors just want to be able to enjoy themselves for the most part when their working hours are done for the day. That's why so few of them serve rural populations, even if they had the intentions of doing so when they first started training.

How to fix the problem? No clue, but here are a few ideas to start. Guarantee/expand loan forgiveness after X years of service to rural populations. These programs already exist in some capacity but there is no guarantee they will still be around the future. If you guarantee if, there's less risk for somebody to take on the offer.

There's probly other stuff you could do but it's midnight and I'm behind on lectures.

(For the record I absolutely do not mean to disparage rural locations as that is where I was brought up and intend to return after training. Just trying to provide some reasoning)

The rate at which doctors from rural areas return to those same areas would be an interesting study. But the reasoning here is solid and I can relate. I'll ultimately go wherever this path takes me, but given the choice I'd like to live in a place with more than two restaurants and one red light.

First, there isn't a "shortage", but a maldistribution. The words matter a lot because how you address these problems is very different.

Second, it appears that most professionally educated people don't want to go work in underserved rural areas. People have tried a variety of approaches to sweeten the pot to no avail. and this is not a new problem, but with the aging of the baby boomer generation it is becoming a bigger problem.

There's no easy fix. Some form of loan forgiveness, high pay and mortgage assistance might be the best you can do, but these areas are partly underserved because they aren't cash rich. At the same time actively recruiting and giving preference to med school applicants with rural roots probably helps too.

This incentive problem seems like the biggest hurdle in terms of providing more care to rural areas. I think subsidizing rural care in the form of loan forgiveness or the like may work to some extent, in that any amount of care is better than none, but I'd like to think there's a better way. I actually think finding a better way to serve rural populations is one of the more exciting opportunities in medicine right now.

Maybe some combination of online consulting or some other means of utilizing the internet to reduce the distance between physician and patient would be a good place to start. I don't know enough about either the legality or the day-to-day aspects of medicine yet to evaluate a concept like that but I'd think any alternative solution would have to be an improvement to hoping enough people turn down the advantages of living in a larger city.

 

[Psai]

The rate at which doctors from rural areas return to those same areas would be an interesting study. But the reasoning here is solid and I can relate. I'll ultimately go wherever this path takes me, but given the choice I'd like to live in a place with more than two restaurants and one red light.



This incentive problem seems like the biggest hurdle in terms of providing more care to rural areas. I think subsidizing rural care in the form of loan forgiveness or the like may work to some extent, in that any amount of care is better than none, but I'd like to think there's a better way. I actually think finding a better way to serve rural populations is one of the more exciting opportunities in medicine right now.

Maybe some combination of online consulting or some other means of utilizing the internet to reduce the distance between physician and patient would be a good place to start. I don't know enough about either the legality or the day-to-day aspects of medicine yet to evaluate a concept like that but I'd think any alternative solution would have to be an improvement to hoping enough people turn down the advantages of living in a larger city.

It's very hard to do a physical with tele medicine and you are opening yourself up to an enormous amount of liability

 

[Law2Doc]

It's very hard to do a physical with tele medicine and you are opening yourself up to an enormous amount of liability

I don't know that the real issue here is liability per se. But most of the underserved issues we are talking about are really primary care issues, and if you can't put hands on your patient you really can't do this job. There's very little you are going to diagnose through FaceTime and the proponents of such tele-medicine are almost always people who have never practiced medicine.

Not a realistic or useful option. Much of the diagnosis comes from other than what the patient tells you verbally --palpating, auscultations and physical manipulation are important diagnostic tools. A patient doesn't come in with a cough and so you just send them for an X-ray. You auscultate and palpate. The guy who comes in and says he has back pain -- you don't just write him a script for pain Meds, you push on his spine, level by level. Reading X-rays or EKGs remotely -- sure no problem, but this was never the part of medicine that was the issue. Primary care requires you to be in the same room.

 

[Law2Doc]

... I don't know enough about either the legality or the day-to-day aspects of medicine yet to evaluate a concept like that but I'd think any alternative solution would have to be an improvement to hoping enough people turn down the advantages of living in a larger city.

See my post above. The problems of (domestic) tele-medicine are not "legality" per se -- there are licensure issues but probably not insurmountable. The problems are logistics. If you can't be in the room with the patient you can't do a lot of this job. The parts that could be done remotely were never really the big issue. So the ONLY fixes are ones where the patient and a caregiver can be in the same room. So either you lure a doctor to this area, or these people will need to see someone other than a doctor. Both these solutions are complex, and as far as physicians are concerned, the latter is untenable because if you let non physicians practice medicine in one place you won't be able to keep them from providing the same services every place.

 

[Mad Jack]

Why is primary care such a major focus for many schools? In particular, the focus on rural communities? I don't get why this is such a big issue.

I don't understand why the focus is on pushing more physicians into rural areas? If it were a better option, there would be more in rural areas. And if it is such a pressing issue, why are primary care physicians among the least compensated?

I just write this as I'm looking through MSAR and seeing how many schools seem to put a major focus on primary care relative to other aspects of medicine. I myself am from a rural area, so I'm not talking negatively here. There just seems to be an economic disconnect when one of the least compensated areas of medicine is apparently considered so important to most schools.

You can make more in rural primary care than you can in big city specialty medicine much of the time. The average PCP in Arkansas pulls 330k, while the average specialist in DC pulls under 300k. Considering the training and liability differences, that seems pretty economically sound to me.

 

[TallPreMed]

I grew up in a rural area on a farm. I now live in a city. While I loved my time on the farm and appreciate all that growing up in the country taught me, I will NEVER return to that lifestyle. Even if it meant a higher compensation or loan forgiveness.

Which may be the mindset of many who come from a rural area. N=1 and all but I'm sure other rednecks like me feel similarly.

 

[NickNaylor]

This incentive problem seems like the biggest hurdle in terms of providing more care to rural areas. I think subsidizing rural care in the form of loan forgiveness or the like may work to some extent, in that any amount of care is better than none, but I'd like to think there's a better way. I actually think finding a better way to serve rural populations is one of the more exciting opportunities in medicine right now.

Maybe some combination of online consulting or some other means of utilizing the internet to reduce the distance between physician and patient would be a good place to start. I don't know enough about either the legality or the day-to-day aspects of medicine yet to evaluate a concept like that but I'd think any alternative solution would have to be an improvement to hoping enough people turn down the advantages of living in a larger city.

The programs you mention - for example, loan forgiveness - are already there. See, for example, the NHSC, which has programs that you pay you an additional stipend in addition to your usual salary for working in "underserved" areas that they define.

I agree with what others have said, which is that compensation alone is the problem per se. I think the average person that goes to medical school just has no interest in going to rural areas. Forgive the caricature, but the average doctor is a well-educated person who is likely an intellectual to some degree that enjoys culture, a nice lifestyle (e.g., nice restaurants, being able to "go and do things"), and other things that a larger, more urban environment can offer that a rural environment can't. Speaking from my own experience, I knew many people that could be offered tons of money yet would never go to anywhere that is legitimately "rural" much less south of the Mason-Dixon line or anywhere that would be considered "southern." The number of people that come from these communities is fairly small, thus the inherent interest in practicing in these communities is fairly small. This is independent of the numerous advantages and opportunities that are available in rural areas than in more urban areas.

Will more financial incentives bring more people into practicing in rural areas? Probably. Will it be a significant number? I'm skeptical. Why? Because ultimately it's not the finances that bring someone to practice in a rural area (in most cases) - it's the "intangibles" that a rural area oftentimes can't offer that drives people away from them.

The reasons for not going into primary care is a completely different topic, and the reasons for pursuing specialization over primary care medicine are numerous. Some of them have been listed here. Again, though, I would argue that for many folks, simply increasing the salary of your average primary care doc is unlikely to "move the needle" in terms of getting more docs where they're most needed.

 

[Law2Doc]

The programs you mention - for example, loan forgiveness - are already there. See, for example, the NHSC, which has programs that you pay you an additional stipend in addition to your usual salary for working in "underserved" areas that they define.

I agree with what others have said, which is that compensation alone is the problem per se. I think the average person that goes to medical school just has no interest in going to rural areas. Forgive the caricature, but the average doctor is a well-educated person who is likely an intellectual to some degree that enjoys culture, a nice lifestyle (e.g., nice restaurants, being able to "go and do things"), and other things that a larger, more urban environment can offer that a rural environment can't. Speaking from my own experience, I knew many people that could be offered tons of money yet would never go to anywhere that is legitimately "rural" much less south of the Mason-Dixon line or anywhere that would be considered "southern." The number of people that come from these communities is fairly small, thus the inherent interest in practicing in these communities is fairly small. This is independent of the numerous advantages and opportunities that are available in rural areas than in more urban areas.

Will more financial incentives bring more people into practicing in rural areas? Probably. Will it be a significant number? I'm skeptical. Why? Because ultimately it's not the finances that bring someone to practice in a rural area (in most cases) - it's the "intangibles" that a rural area oftentimes can't offer that drives people away from them.

The reasons for not going into primary care is a completely different topic, and the reasons for pursuing specialization over primary care medicine are numerous. Some of them have been listed here. Again, though, I would argue that for many folks, simply increasing the salary of your average primary care doc is unlikely to "move the needle" in terms of getting more docs where they're most needed.

Translation -- if you want to attract doctors to a rural area, start building malls, symphonies, ballparks and infrastructure. The Doc Hollywood notion that someone on a high powered career path is going to settle in to rural America makes for a cute movie but it doesn't happen in real life.

 

[Mad Jack]

I grew up in a rural area on a farm. I now live in a city. While I loved my time on the farm and appreciate all that growing up in the country taught me, I will NEVER return to that lifestyle. Even if it meant a higher compensation or loan forgiveness.

Which may be the mindset of many who come from a rural area. N=1 and all but I'm sure other rednecks like me feel similarly.

I thought much like you until very recently. For whatever reason, the quiet life is calling me back. Thought I'd end up being in the big city and all that, now I just want to live in some little town with a population of 10-50k in the middle of nowhere.

 

[TallPreMed]

I thought much like you until very recently. For whatever reason, the quiet life is calling me back. Thought I'd end up being in the big city and all that, now I just want to live in some little town with a population of 10-50k in the middle of nowhere.

Yeah, I'm about twenty five as well, so "city living" is what is most attractive to me at this point because it is so catered to people in their 20s/30s. Maybe my mind will change in the future when I wake up and suddenly miss going out, throwing a saddle on my horse, and riding on a spring summer morning.

 

[musicalfeet]

Translation -- if you want to attract doctors to a rural area, start building malls, symphonies, ballparks and infrastructure. The Doc Hollywood notion that someone on a high powered career path is going to settle in to rural America makes for a cute movie but it doesn't happen in real life.

As someone who has worked in another field, do you feel that perhaps rural areas are also in need of other services besides healthcare? Another user pointed out that nowadays, doctors are now married to spouses who often also work in other somewhat high-powered fields that are location based (law, engineering, etc) in which they can't work in rural areas. Aside from a lack of access to primary care, I wonder if rural areas also have a lack of access to other resources? By bringing some of those industries into rural areas, perhaps it would make it more enticing and easier for those that work in other industries for people to settle there?

 

[Law2Doc]

As someone who has worked in another field, do you feel that perhaps rural areas are also in need of other services besides healthcare? Another user pointed out that nowadays, doctors are now married to spouses who often also work in other somewhat high-powered fields that are location based (law, engineering, etc) in which they can't work in rural areas. Aside from a lack of access to primary care, I wonder if rural areas also have a lack of access to other resources? By bringing some of those industries into rural areas, perhaps it would make it more enticing and easier for those that work in other industries for people to settle there?

It's not bad in theory, but I think much harder to implement in other fields and here is why. In medicine you usually already have hospitals in place and are in the position of trying to attract doctors to come work there. In law, you don't even have the firms there, so you are a step further removed from the necessary infrastructure. Also you can pretty much guaranty a doctor a steady stream of income at a certain level, thanks to Medicaid/Medicare. It's much harder to do in law, where there aren't government payors.
I think this is all very field of dreams -- "if you build it, they will come".

 

[Petrichor1]

why should it not be? I am not liking the encroachment of NPs and PAs trying to become doctors in these areas; I for one prefer the doctor and with first-hand experience too as to explain why. Primary care is amazing and we need doctors there as our society moves towards Preventative care. We need pros for that...not secondary providers. Think about it, if most entering med students become specialists, these secondary providers will do primary care and sooner or later their annoying "agenda" will come to the precious specialty fields you care so much about. This is a pretty stupid thought but just think about it and appreciate the importance of primary care emphasis.

 

[NickNaylor]

why should it not be? I am not liking the encroachment of NPs and PAs trying to become doctors in these areas; I for one prefer the doctor and with first-hand experience too as to explain why. Primary care is amazing and we need doctors there as our society moves towards Preventative care. We need pros for that...not secondary providers. Think about it, if most entering med students become specialists, these secondary providers will do primary care and sooner or later their annoying "agenda" will come to the precious specialty fields you care so much about. This is a pretty stupid thought but just think about it and appreciate the importance of primary care emphasis.

You have pretty much summarized the primary care problem in a nutshell. The problem is that when debt, years of training, and wanting to "live life" are facing you directly, platitudes like "primary care is important" really don't do much to convince people to become PCPs when there are things they find just as interesting yet get them a much better lifestyle.

 

[22031 Alum]

Translation -- if you want to attract doctors to a rural area, start building malls, symphonies, ballparks and infrastructure. The Doc Hollywood notion that someone on a high powered career path is going to settle in to rural America makes for a cute movie but it doesn't happen in real life.

There's a reason why every single recruiting email I get (dozens a week) makes a clear effort to mention local amenities like restaurants, symphonies, ballparks and even airports. Not many professional types will choose to live without such things.

 

[Petrichor1]

You have pretty much summarized the primary care problem in a nutshell. The problem is that when debt, years of training, and wanting to "live life" are facing you directly, platitudes like "primary care is important" really don't do much to convince people to become PCPs when there are things they find just as interesting yet get them a much better lifestyle.

I continuously see schools vouch for scholarships on behalf of PCP aspirants. I think medical schools should really focus on that. However, there will always be candidates that can switch so not sure about its statistical successes. 10 year rural loan forgiveness plans are a gamble since most doctors want to live in the city and while doing PCP there would net greater income, their own children would be at disparity for an education they only know is getting more competitive and cut-throat. To top that off, there are top rated PCPs associated with well known institutes that actually encourage PA/NP growth and encroachment. Which profession do you think management would choose? lol, 2 physicians to man 10 PAs.

 

[NickNaylor]

I continuously see schools vouch for scholarships on behalf of PCP aspirants. I think medical schools should really focus on that. However, there will always be candidates that can switch so not sure about its statistical successes. 10 year rural loan forgiveness plans are a gamble since most doctors want to live in the city and while doing PCP there would net greater income, their own children would be at disparity for an education they only know is getting more competitive and cut-throat. To top that off, there are top rated PCPs associated with well known institutes that actually encourage PA/NP growth and encroachment. Which profession do you think management would choose? lol, 2 physicians to man 10 PAs.

Even if you gave people free tuition in return for going to into primary care there would likely be people that wouldn't go into it. It's a grueling practice environment that not everyone is into. That's kind of the point being made throughout this entire thread, whether the issue is going out to rural areas or going into primary care: money isn't everything, and even with a ton of financial carrots it's questionable how strong the pull will be with those carrots.

 

[Petrichor1]

Even if you gave people free tuition in return for going to into primary care there would likely be people that wouldn't go into it. It's a grueling practice environment that not everyone is into. That's kind of the point being made throughout this entire thread, whether the issue is going out to rural areas or going into primary care: money isn't everything, and even with a ton of financial carrots it's questionable how strong the pull will be with those carrots.

true, it is thereafter the pain we bear as society. I don't blame physicians for this with the everso changing tides in healthcare, people don't know where 5 years from now will take us.

 

[supremetaco]

This stems from what people have said about there being less doctors located in rural areas, but preventive medicine is almost nonexistent. There is a huge lack of medical knowledge, and so the types of cases you see in rural areas are very chronic and many times advanced, driving many docs away from there. Furthermore, the sheer volume of people ill due to what are minimized cases in the urban/suburban areas like general hygiene or basic sanitation is enormous. The increased compensation is one way government is trying to combat this need for care, but its an ugly cycle of lack of doctors->lack of medical knowledge ->increased number of cases, both acute and chronic->need for docs. US population is growing at a pace that is faster than the number of primary care docs per year, so the ratio of patients : docs, especially in rural areas, is purported to increase every year. With docs being drawn to suburban/urban lifestyles, rural areas are left with increased need.

 

[Law2Doc]

...on behalf of PCP aspirants...

This sounds like what you might lavage out of an AIDS patients lungs...

 

[Law2Doc]

This stems from what people have said about there being less doctors located in rural areas, but preventive medicine is almost nonexistent. There is a huge lack of medical knowledge, and so the types of cases you see in rural areas are very chronic and many times advanced, driving many docs away from there. Furthermore, the sheer volume of people ill due to what are minimized cases in the urban/suburban areas like general hygiene or basic sanitation is enormous. The increased compensation is one way government is trying to combat this need for care, but its an ugly cycle of lack of doctors->lack of medical knowledge ->increased number of cases, both acute and chronic->need for docs. US population is growing at a pace that is faster than the number of primary care docs per year, so the ratio of patients : docs, especially in rural areas, is purported to increase every year. With docs being drawn to suburban/urban lifestyles, rural areas are left with increased need.

Not accurate. First, the more advanced cases are actially a big draw for doctors, not keeping people away. you want a place that does a decent volume of complex cases. You are going to pick a career that you find interesting, not mind numbing my easy. Doctors WANT to see cool cases. The doctors who just want to treat the sniffles are the ones that you should always avoid, and they are all going to be replaced by mid levels anyhow. If you wanted to see a few basically healthy people each day you never wanted to be a doctor -- you aren't adding value, and will never have that "job well done, I made a difference" feeling. It's really truly the location, and only the location, that's the big problem. A city kid from NY is NEVER going to move to rural Iowa far away from airports and shopping and entertainment and friends for a few extra bucks and a bigger house. It's an ever decreasing subset of doctors who want to move to greener pastures and that's the whole problem, not patient demographics or lack of preventative care. Preventative care is obviously important and needed, but that's not really impacting on this issue.

Second, you seem to be buying into the "doctor shortage" propaganda, with your whole "US population is growing faster than the number of primary care doctors". This isn't accurate, has been shown to be inaccurate. It's totally fabricated propaganda by people with interests in increasing med school enrollment and residency numbers -- there actually isn't a shortage. The baby boomers are starting to die out and the generation behind them is somewhat smaller. What there is is a horrible distribution problem, where we have gluts of doctors in the coastal cities fighting for the same few jobs and far too few people serving the underserved in rural Anerica. So the raw number of doctors is fine, but they aren't going where you need them most. You cannot ever fix this by generating more doctors -- you just make the problem worse. This was my point above about not framing this as a "doctor shortage" because it's not the actual problem and sends you off on the wrong solution.

 

[Petrichor1]

This sounds like what you might lavage out of an AIDS patients lungs...

lol didn't realize the double connotation

 

[oldbearprofessor]

Doctors WANT to see cool cases. The doctors who just want to treat the sniffles are the ones that you should always avoid, and they are all going to be replaced by mid levels anyhow. If you wanted to see a few basically healthy people each day you never wanted to be a doctor -- you aren't adding value, and will never have that "job well done, I made a difference" feeling. It's really truly the location, and only the location, that's the big problem. A city kid from NY is NEVER going to move to rural Iowa far away from airports and shopping and entertainment and friends for a few extra bucks and a bigger house.

There are many things that motivate very good pediatricians. One of them is watching families grow and practicing outstanding preventative medicine for children. There is no evidence that I am aware of that pediatricians who do not care for many hospitalized (or very sick) patients are not good ones, do not feel like they are making a difference, or should be avoided. The practice location is a problem for pediatrician recruitment, but it's not just the lack of shopping malls, etc. It is also the challenges of being a solo pediatrician in a relatively isolated setting. That means attending deliveries in the middle of the night, no one to cross cover for call (or at the least, difficulties in setting up cross-coverage) and a need to be comfortable and confident in the business side of outpatient medicine. The salary issue is more complex, it is not always the case that rural pediatrics pays more than non-rural, at least unless you define non-rural as within 10 miles of Fenway Park.

 

[Law2Doc]

...The practice location is a problem for pediatrician recruitment, but it's not just the lack of shopping malls, etc. It is also the challenges of being a solo pediatrician in a relatively isolated setting. That means attending deliveries in the middle of the night, no one to cross cover for call (or at the least, difficulties in setting up cross-coverage) and a need to be comfortable and confident in the business side of outpatient medicine...

Yes but this is all very different than the prior poster suggesting doctors don't want to deal with chronic and advanced disease and that's why they avoid rural settings.

 

[Officer Farva]

Do people seriously aspire to be primary care docs or is it just a field they get sucked into? I know 4 primary care docs, all of them recommend doing something else in medicine or choosing a new career. One of those primary care docs was some genius neurosurgeon in his home country!

 

[doc05]

Do people seriously aspire to be primary care docs or is it just a field they get sucked into? I know 4 primary care docs, all of them recommend doing something else in medicine or choosing a new career.

you will hear this advice from docs in virtually all specialties. it's a matter of the grass always being greener on the other side.

 

[12375711]

Do people seriously aspire to be primary care docs or is it just a field they get sucked into?/QUOTE]

Is this a serious question?

I'm assuming none of us said we wanted to go into medicine for the money straight out in our applications, so I can see where it might surprise you that some in the group interview might be telling the truth instead of lying when we said we wanted to do primary care...

 

[Law2Doc]

Do people seriously aspire to be primary care docs or is it just a field they get sucked into? I know 4 primary care docs, all of them recommend doing something else in medicine or choosing a new career. One of those primary care docs was some genius neurosurgeon in his home country!

You try your hand at various specialties in third year med school, and pick the one you like best. People who like working with kids or babies do peds. People who like to interact with patients more longitudinally may pick FM/IM. There's appeal to all these fields and you'll be surprised how much you like some and not others. Ultimately you'll choose. Your board scores and Evaluations may have an impact in your universe of choices but in general as a US grad the ultimate specialty you choose will be totally voluntary, not something you are shunted into.

 

[mcatjelly]

Do people seriously aspire to be primary care docs or is it just a field they get sucked into? I know 4 primary care docs, all of them recommend doing something else in medicine or choosing a new career. One of those primary care docs was some genius neurosurgeon in his home country!

When I was growing up, I always viewed becoming a doctor as becoming a PCP. I've been working with patients as a tech on a long-term unit for almost 2 years now and I love the longitudinal relationships, becoming a part of their support system, dealing with all aspects of health (physical, mental, sociological), etc. It's weird to me that you genuinely can't see why anyone, not just yourself, would be attracted to primary care!

To be fair, it helps that I've grown up with a parent in primary care who so clearly loves what they do in spite of the system.

 

[supremetaco]

Not accurate. First, the more advanced cases are actially a big draw for doctors, not keeping people away. you want a place that does a decent volume of complex cases. You are going to pick a career that you find interesting, not mind numbing my easy. Doctors WANT to see cool cases. The doctors who just want to treat the sniffles are the ones that you should always avoid, and they are all going to be replaced by mid levels anyhow. If you wanted to see a few basically healthy people each day you never wanted to be a doctor -- you aren't adding value, and will never have that "job well done, I made a difference" feeling. It's really truly the location, and only the location, that's the big problem. A city kid from NY is NEVER going to move to rural Iowa far away from airports and shopping and entertainment and friends for a few extra bucks and a bigger house. It's an ever decreasing subset of doctors who want to move to greener pastures and that's the whole problem, not patient demographics or lack of preventative care. Preventative care is obviously important and needed, but that's not really impacting on this issue.

Second, you seem to be buying into the "doctor shortage" propaganda, with your whole "US population is growing faster than the number of primary care doctors". This isn't accurate, has been shown to be inaccurate. It's totally fabricated propaganda by people with interests in increasing med school enrollment and residency numbers -- there actually isn't a shortage. The baby boomers are starting to die out and the generation behind them is somewhat smaller. What there is is a horrible distribution problem, where we have gluts of doctors in the coastal cities fighting for the same few jobs and far too few people serving the underserved in rural Anerica. So the raw number of doctors is fine, but they aren't going where you need them most. You cannot ever fix this by generating more doctors -- you just make the problem worse. This was my point above about not framing this as a "doctor shortage" because it's not the actual problem and sends you off on the wrong solution.

There is a difference between weeping lesions and neuropathy due to unmanaged diabetes and a developing cancer. Both are chronic and advanced, but are entirely different in management. It's the former that physicians, namely PCP's, dislike. The US population is growing faster per capita than the number of PCPs. You may be referring to the study showing it's specialties that are keeping pace, but the PCP/family meds are not. There have been multiple meta analyses showing this.

 

[Goro]

My students self-select for Primary Care because my school is known for it. My Primary Care clinical colleagues (both MD and DO) love their jobs and their patients.

Take the software job, Farva....you're starting to reek of troll.

Do people seriously aspire to be primary care docs or is it just a field they get sucked into? I know 4 primary care docs, all of them recommend doing something else in medicine or choosing a new career. One of those primary care docs was some genius neurosurgeon in his home country!

 

[GreenScrubss]

I think ppl who say "nobody wants primary care" or that "family docs just failed into FM" realize what they are saying is ridiculous most of the time

I personally know a whole clinic of family docs who wouldn't choose any other specialty.

I myself am not into family medicine as a career but somebody who thinks nobody wants to be a family doctor is 1) delusional 2) has little exposure to family physicians 3) doesn't realize others have different opinions than theselves.

Obviously my opinion tho.

 

[whatever5]

Obviously location is a big deal. No one wants to live in the middle of nowhere during the "best years of our lives" that we're giving up for medicine, and for older students who are in a relationship, good luck convincing your SO to move to the middle of nowhere where there are no jobs.

 

[Law2Doc]

...The US population is growing faster per capita than the number of PCPs. You may be referring to the study showing it's specialties that are keeping pace, but the PCP/family meds are not. There have been multiple meta analyses showing this.

For the most part these "studies" that suggest a doctor shortage have been politically motivated and poorly designed. There are interest groups that want the US to increase med school and residency slots for their own benefit and there are groups that want licensing boards to concede doctors can't do it all and throw open the doors to other fields. Politically motivated "science" is the worst kind of science.

The consensus within the medical community is that there is no shortage and that the problem is one of distribution/allocation. It's a much harder problem to fix. It means you could double the output of doctors and you'd just worsen gluts in some places without fixing the problem. You really can't force people on a high powered career trajectory to go live on the farm, exchanging healthcare for fresh eggs. So all you can do is recruit people from these communities who might go back, and otherwise try to entice people to relocate to these places. As mentioned though, the money might be better spent building malls, ballparks and airports than offering them up as salaries.