A push to train more primary-care doctors (LAT)

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
costales

costales

Full Member
10+ Year Member
Joined
Jul 25, 2011
Messages
2,183
Reaction score
2,962
http://www.latimes.com/health/la-me-primarycare-20120219,0,250503.story
A push to train more primary-care doctors
The pay is relatively low, the hours are long, the need is great and, students are finding, the rewards can be immense.
By Anna Gorman, Los Angeles Times
February 19, 2012

68196129.jpg
Members don't see this ad.
 
California isn't a doctor friendly state.

High COL
High malpractice
High Taxes

So yea- not really shocked
 
Poliscidoc said:
California isn't a doctor friendly state.

High COL
High malpractice
High Taxes

So yea- not really shocked
Click to expand...

You're not from California, are you

COL is not high everywhere: if you live in LA or the Bay Area, year, COL is high, but it's lower in SD, Sacremento, Fresno, Bakersfield, Stockton, and most rural areas.

California malpractice is not the highest nor the lowest in the nation; to say it is 'high' is not accurate.
 
Members don't see this ad :)
No, I don't live in California I was really going off the article and a couple of the docs I have shadowed. They all moved from California because they said the things I mentioned above where true. Maybe there malpractice was group or specialty specific and they did work in LA so maybe they are a little biased.

But, let's be honest the women in the article goes to USC. Tuition isn't cheap their and primary care docs aren't making enough money to justify going into the field. I understand that medicine is about helping people but its hard to help people when your being killed by high student loan debt, higher taxes, and malpractice insurance that is expensive. So until the government or somebody does something to fill the gap these stories are all you will get. Her story is nice and sweet but people aren't lining up to follow her.
 
Eh, as much as I enjoy helping people, I'm going into medicine and my speciality of choice based on my needs. I'm going to choose a field that I'm genuinely interested in, has nice hours, decent compensation, and a population I can handle ( so go away pediatrics). But yes, I wouldn't want to sacrifice my life and slave over a career for the 'greater good' of society. I'm quite content doing what I like and helping people in that way.
 
serenade said:
Eh, as much as I enjoy helping people, I'm going into medicine and my speciality of choice based on my needs. I'm going to choose a field that I'm genuinely interested in, has nice hours, decent compensation, and a population I can handle ( so go away pediatrics). But yes, I wouldn't want to sacrifice my life and slave over a career for the 'greater good' of society. I'm quite content doing what I like and helping people in that way.
Click to expand...

yea for real.

There will be a primary care shortage as long as PCPs get paid half of what specialists are paid without any compensation whatsoever.

We can't count on the hearts of the self-sacrificing minority who will choose to be family practitioners.
 
It's true that if compensation was better then you'd get more people going into it. Personally, I would never touch a family medicine residency. I'd take internal med over it any time. It wouldn't matter to me how "rewarding" family medicine is because I wouldn't want to throw all I worked hard for into the waste basket for crap returns.
 
Yea that Harvard student in the article talking about the rewards of family medicine is trippin'.
 
MrBird said:
yea for real.
There will be a primary care shortage as long as PCPs get paid half of what specialists are paid without any compensation whatsoever.
We can't count on the hearts of the self-sacrificing minority who will choose to be family practitioners.
Click to expand...
QFT - and especially a shortage of good ones. People end up falling back on primary care because they can't match into a higher-paid specialty, so we get the least-qualified doctors in what are arguably the most important fields.
 
Listen, if I could be the primary care provider of a good list of people and manage their care and medications across multiple care providers and specialists and I got compensated well to do it, sign me up!

Either or doesn't cut it in our current American system.
 
yea our system is a POS.
 
Members don't see this ad :)
Poliscidoc said:
False, I believe were ranked in the top 40 or so (maybe 36- don't feel like googling). We just have a crappy ROI.
Click to expand...
Because we are top 40 doesn't mean our system isn't a POS. It would imply that more systems are a POS as well.
 
Poliscidoc said:
Isn't this the reason that NY is considered medically underserved?
Click to expand...

No that's more related to the fact that NYC basically could not possibly have enough physicians to cover its dense population and upstate NY (with some exceptions) is just plain too sparesly populated to have healthcare facilities within the correct distances of all the population.

NY is basically a massively overpopulated-underserved area (excluding midtown and the UES, where physicians are probably 10% of the populace) with a giant expanse of wide open land with almost no physician presence to the north.

The only correctly served areas of any size are midtown/UES, a decent swatch of the Hudson Valley and immediate NYC suburbs, and Long island. Maybe there are spots of good coverage here and there near the upstate medical schools. But its mostly underserved cause the population extremes and crappy highway system (based on indian trails and not having to cut through gigantic mountains everywhere) make transportation and proper physician numbers a nightmare in the city or upstate.
 
MrBird said:
There will be a primary care shortage as long as PCPs get paid half of what specialists are paid without any compensation whatsoever.
Click to expand...
Not really.

There will be a shortage of PCPs as long as no one bothers to increase the number of residency positions in primary care fields.

There are far more residency positions out there than there are American medical graduates, and the total number of residency positions out there has been roughly stable for years. Even if individual schools start programs to increase student interest, all that will do is shunt a few American grads out of specialties and into primary care, thereby increasing the relative percentage of Americans in primary care, but doing nothing to increase the actual number of PCPs out there.

The only way to increase the number of PCPs is to increase the number of training positions. If the ACGME was to open up a thousand new training positions in family and peds next year, I can guarantee they would be able to find a thousand IMGs to fill those positions. The problem is that no one wants to pay for that, and so they'd rather spend their time whining about how specialists are ruining primary care.
 
Skinceutical said:
Not really.

There will be a shortage of PCPs as long as no one bothers to increase the number of residency positions in primary care fields.

There are far more residency positions out there than there are American medical graduates, and the total number of residency positions out there has been roughly stable for years. Even if individual schools start programs to increase student interest, all that will do is shunt a few American grads out of specialties and into primary care, thereby increasing the relative percentage of Americans in primary care, but doing nothing to increase the actual number of PCPs out there.

The only way to increase the number of PCPs is to increase the number of training positions. If the ACGME was to open up a thousand new training positions in family and peds next year, I can guarantee they would be able to find a thousand IMGs to fill those positions. The problem is that no one wants to pay for that, and so they'd rather spend their time whining about how specialists are ruining primary care.
Click to expand...

What can we do?
 
Poliscidoc said:
Either pay people more or reduce the cost of becoming a PCP.
Click to expand...
Neither of which will do anything to increase the total number of PCPs being trained if the number of residency positions doesn't increase.
 
Skinceutical said:
Neither of which will do anything to increase the total number of PCPs being trained if the number of residency positions doesn't increase.
Click to expand...

How do we increase the number of residency positions if hospitals can't afford it?
 
Skinceutical said:
Neither of which will do anything to increase the total number of PCPs being trained if the number of residency positions doesn't increase.
Click to expand...


PCP spots aren’t competitive and aren’t being filled soquickly that we have an excess of medical graduates working at Starbucks.Increasing the supply does nothing except create spots that people won’t rank.You have to increase the draw or appeal of primary car before you decide toopen the flood gates. I understand you’re a resident so did you choose primarycare? If you did may I ask why and what kind of student loan debt do you face?Would you recommend a WVSOM grad to go into primary care when per year he/sheis borrowing nearly $80,000?
 
Poliscidoc said:
PCP spots aren’t competitive and aren’t being filled soquickly that we have an excess of medical graduates working at Starbucks.Increasing the supply does nothing except create spots that people won’t rank.You have to increase the draw or appeal of primary car before you decide toopen the flood gates
Click to expand...
Primary care positions (at least in the ACGME match) aren't going unfilled. In 2011, 98.9% of internal medicine (categorical) positions, 98.2% of pediatric positions, and 94.4% of family medicine positions were filled through the match alone. The vast majority of the unmatched positions were snapped up during the scramble, and when all was said and done, there were still plenty of unmatched IMGs who would have sold their right arm for a shot at an FP residency in Alabama.

To put it in perspective, in 2011 there were a total of 528 ACGME residency positions (excluding prelims) that went unfilled during the match (almost all of which were likely filled during the scramble). That same year, nearly 6,000 foreign medical graduates alone went unmatched. Obviously, those people would be willing to fill the primary care shortage, if there were residency positions available for them.
 
MrBird said:
How do we increase the number of spots when the government can't afford it?
Click to expand...
You can't. Blaming American medical students for choosing careers in more lucrative specialties isn't going to change anything either.

We might start by not getting involved in unwinnable wars overseas, which might free up a couple hundred billion a year. Then again, all that money is likely being borrowed from China and wasn't ours to begin with anyways.
 
Skinceutical said:
You can't. Blaming American medical students for choosing careers in more lucrative specialties isn't going to change anything either.

We might start by not getting involved in unwinnable wars overseas, which might free up a couple hundred billion a year. Then again, all that money is likely being borrowed from China and wasn't ours to begin with anyways.
Click to expand...

So...you're saying there's nothing that can be done? This is it? We're just screwed? :cry:
 
So all in all no real plan because it all requires money. And doctors make to much money and they should work for free.


Sent from my iPhone using SDN Mobile app
 
Skinceutical said:
Not really.

There will be a shortage of PCPs as long as no one bothers to increase the number of residency positions in primary care fields. .
Click to expand...

FP + IM is already 48% IMGs. (42% of FP and 54% of IM). Given the class size and number of schools in the US is rapidly increasing, we're just gonna fill the extant slots with US students and push out the IMGs. You're totally right that the only way to act on the shortage is to increase training (likely will not happen for years and years and years), but what is perhaps more important is to not increase the training size and just flood the market with lower level applicants. Make sure when we expand the FP/IM pool its because we have enough US applicants to at least come close to filling the extant slots. Right now we are not even close. At all.
 
Poliscidoc said:
Either pay people more or reduce the cost of becoming a PCP. Either one not likely to happen...
Click to expand...
Or pay specialists less (that is to say, make it harder for them to write their own ticket / create their own demand).
 
MrBird said:
yea for real.

There will be a primary care shortage as long as PCPs get paid half of what specialists are paid without any compensation whatsoever.

We can't count on the hearts of the self-sacrificing minority who will choose to be family practitioners.
Click to expand...

So a genuine question for the pre-meds and MS1s/MS2s, from a current Family Medicine 3rd year resident.

Let's say that primary care salaries stay where they are, which is in the $150K-$175K range (and that's speaking very conservatively; in some parts of the country, you often see primary care salaries in the $200K and above range).

IF primary care salaries stayed where they are, but the government (or some other agency) offered significant loan repayment throughout your residency until your loans were completely paid off, would that make you more likely to go into primary care?

I'm really curious. There's a lot of talk about trying to increase the PCPs in America, but the people proposing solutions seem a little out of touch from actual med students.
 
If you're saying the gov't would repay 250k+ in loans during a 3 year FP residency? Sign me up.
 
Keep funding those NHSC programs in underserved areas if you want more PCPs in places that need them the most. Especially fund the full NHSC scholarship program, not just the partial loan repayment program. Blanket repayment of PCP loans would not help oversaturated PCP areas.

Thing is, I still believe people will primarily be driven to primary care based on if they actually like it. Everyone makes a big hoot about how little PCPs get paid, but there are still plenty of classmates who still go onto PCP fields - in the end, we're going to pay it off as long as we make sensible purchases. The people who don't choose PCP aren't being driven away due to low pay - they'd just prefer the more immediate gratification from surgically oriented fields or the more technical skills other fields need.
 
smq123 said:
So a genuine question for the pre-meds and MS1s/MS2s, from a current Family Medicine 3rd year resident.

Let's say that primary care salaries stay where they are, which is in the $150K-$175K range (and that's speaking very conservatively; in some parts of the country, you often see primary care salaries in the $200K and above range).

IF primary care salaries stayed where they are, but the government (or some other agency) offered significant loan repayment throughout your residency until your loans were completely paid off, would that make you more likely to go into primary care?

I'm really curious. There's a lot of talk about trying to increase the PCPs in America, but the people proposing solutions seem a little out of touch from actual med students.
Click to expand...

I would definitely seriously consider primary care specialties if this was the case. Unless, of course, I also have to work in a rural/underserved area. Then I'd again be put off.
 
smq123 said:
So a genuine question for the pre-meds and MS1s/MS2s, from a current Family Medicine 3rd year resident.

Let's say that primary care salaries stay where they are, which is in the $150K-$175K range (and that's speaking very conservatively; in some parts of the country, you often see primary care salaries in the $200K and above range).

IF primary care salaries stayed where they are, but the government (or some other agency) offered significant loan repayment throughout your residency until your loans were completely paid off, would that make you more likely to go into primary care?

I'm really curious. There's a lot of talk about trying to increase the PCPs in America, but the people proposing solutions seem a little out of touch from actual med students.
Click to expand...

I don't know, maybe when I do my rotations I'll know the answer to this, but for me at least it isn't the money component but rather what the job entails sounds relatively uninteresting. I think i'd want to specialize in something specific as opposed to treating a very broad set of conditions.
 
Yea. For me, it's the money issue. Being in that much debt, getting paid half as much as my contemporaries in other specialties, and having an enormous patient base that will increase exponentially from the Affordable Care Act is making Family Medicine extremely repulsive. The practice itself is fine.
 
DocEspana said:
...but what is perhaps more important is to not increase the training size and just flood the market with lower level applicants. Make sure when we expand the FP/IM pool its because we have enough US applicants to at least come close to filling the extant slots. Right now we are not even close. At all.
Click to expand...
Why are IMGs, by default, "lower level applicants?" The match, as it stands is heavily skewed in favor of American graduates (as well it should be); but that means that there's no dearth of well qualified IMGs who get shut out of the system due to a relative shortage of positions. Again, looking at the 2011 AGCME match data, US seniors with a Step I score between 181-190 (i.e. barely passed with less than a 5 point margin), still had a 93% chance of matching in family (113 out of 112 matched). On the other hand, independent applicants with a score in the 211-220 range (around national average) only had a 42% chance of matching (93 of 224 matched). Is an American graduate who passed Step I by the skin of his teeth really a "higher level applicant" than an IMG who scored at national average?

Yes, I realize that USMLE scores aren't everything. However, they're really our only means of objectively comparing applicants across the board.

The way I see it, we have a shortage of PCPs and a surplus of qualified, foreign trained physicians. It seems like a natural solution to open up more FP residencies (NOT IM, which is just a pathway to subspecialization at this point), with the expectation that those positions will be filled by IMGs.
 
The argument is that the average foreign born IMG self reports spending 9 months (without other obligations) studying for the USMLE step I. The mean US/Canadian born IMG self-reports spending 4-6 months depending on what school they come from. The average US candidate self-reports 3-6 weeks of full dedicated board studying.

It's a point brought up by the PDs a lot. Its usually brought up in the context of how the impressiveness of many exemplary IMGs with 220's (or perhaps even better) is greatly watered down by the larger amount of completely useless IMGs with poor *functional* skills who stroll in with 240's. They use the extended study time argument to both explain why a high scoring applicant can be so inept, and to (unfortunately) question as to why the more skillful IMGs didnt also score in the 240's when the *****s were able to do it.

NOTE: All of this is based on the commentary of a handful of PDs who I have personally interacted with and their collected, and very vocal, sentiments. I may very well live within a self-selecting biased community. I have no idea. I personally believe my experiences to be varied and numerous enough to be at least a *decent* generalization. Feel free to suggest otherwise.
 
DocEspana said:
The argument is that the average foreign born IMG self reports spending 9 months (without other obligations) studying for the USMLE step I. The mean US/Canadian born IMG self-reports spending 4-6 months depending on what school they come from. The average US candidate self-reports 3-6 weeks of full dedicated board studying.
Click to expand...
Which is why I specifically compared match rates to Americans who passed the boards by less than a 5 point margin.

I have far more concerns about the general knowledge base of an American who literally barely passed the USMLE than an IMG who managed to score at the national mean (in some cases despite speaking English as a second language), regardless of study time.

As I said before, any program to increase interest in FP at American medical schools, will at best, slightly increase the percentage of American grads in primary care. It will do nothing to address the supposed shortage of primary care physicians.
 
smq123 said:
So a genuine question for the pre-meds and MS1s/MS2s, from a current Family Medicine 3rd year resident.

Let's say that primary care salaries stay where they are, which is in the $150K-$175K range (and that's speaking very conservatively; in some parts of the country, you often see primary care salaries in the $200K and above range).

IF primary care salaries stayed where they are, but the government (or some other agency) offered significant loan repayment throughout your residency until your loans were completely paid off, would that make you more likely to go into primary care?

I'm really curious. There's a lot of talk about trying to increase the PCPs in America, but the people proposing solutions seem a little out of touch from actual med students.
Click to expand...

sign me up:thumbup:
 
smq123 said:
So a genuine question for the pre-meds and MS1s/MS2s, from a current Family Medicine 3rd year resident.

Let's say that primary care salaries stay where they are, which is in the $150K-$175K range (and that's speaking very conservatively; in some parts of the country, you often see primary care salaries in the $200K and above range).

IF primary care salaries stayed where they are, but the government (or some other agency) offered significant loan repayment throughout your residency until your loans were completely paid off, would that make you more likely to go into primary care?

I'm really curious. There's a lot of talk about trying to increase the PCPs in America, but the people proposing solutions seem a little out of touch from actual med students.
Click to expand...

I would most definitely be interested. In fact, the only fear I have about becoming a PCP is being close to 200K in debt (plus any interest that tags along) and not being able to make the bucks to pay it back. Although I won't start med school for another few months and can really only base my current stance on assumptions, at the moment I'm actually quite keen on the idea of treating a patient population with a wide array of conditions and NOT being a specialist. One would really have to know their $#!+ to be a good PCP (same goes for other fields of course) but I like to think that having solid clinicians on the front lines is one of many things we need to help improve current state of affairs in healthcare.

The best docs I've had were good old family docs and I would be more than proud to follow in their footsteps... assuming I could afford to do so. I'd bet there are a lot of folks out there with similar sentiments. So yeah, I think that more scholarships, government programs, etc could have a positive impact on the current shortage; it would work for me at least. :D
 
You must log in or register to reply here.
Next unread thread

Similar threads

Wjldenver
DO Schools Ranked (Primary Care) in US News 2023-24 Rankings
Replies
4
Views
3K
deleted1139416
D
Sage of Pale Bones
Is not being keen on primary care a red flag?
Replies
7
Views
2K
AlbinoHawk DO
AlbinoHawk DO
J
  • Question
APPLY DO Primary September, complete Mid october?
Replies
17
Views
1K
Angus Avagadro
Angus Avagadro
T
When is late to submit DO primary this cycle?
Replies
10
Views
2K
Goro
Goro
F
Submitting primary in February
Replies
2
Views
721
Goro
Goro
Top