An idea to solve the physician shortage problem

[UrshumMurshum]

---

Members don't see this ad.

According to the AAMC, America faces a shortage of roughly 90,000 physicians in the next 10 years. Roughly half that number in family practice physicians. https://www.aamc.org/download/150584/data/physician_shortages_factsheet.pdf

The government hasn't raised the funding for residencies in the past decade, and it does not seem that will change.

So how does one increase the number of residency slots without increasing the funding?

Well, since the majority of the physician shortage will be concentrated in family practice, the government should work to reverse this trend by reallocating current funds to boost family practice residency salaries. What the number should be I don't know, but above 70,000/year sounds nice enough incentive.

Now for specialty residency slots, since these students will presumably go on to make 2-3 times that of a family practice physician in the private sector, I think it's reasonable to cut the salaries of specialty residencies to zero. Therefore, this should accomplish two things, one it should provide enough funding to boost family practice residency salaries, and it should also allow teaching hospitals to boost the number of slots.

The cost of a specialty residency slot would then be the cost of teaching + educational supply costs. Current funding should presumably then be able to reallocate funds from specialty residency salaries to pay for more teachers + equipment to boost specialty residency slots. The amount of growth might not be explosive, but it should provide at least a few thousand more specialty residency slots a year.

According to AAMC, we need about 9,000 more slots a year over the next ten years to keep up with demand.

So this idea would provide more incentive to students to pursue family practice, and in addition it should create more slots in specialties, thus addressing both issues without increasing government funding for residency slots.

Really this is an issue that needs to be taken up in the 2012 election. Presumably health care is going to be a major issue, and as of yet, I've not heard any candidate talk about how they're going to address the physician shortage.

 

[kpcrew]

lmao cut the salary of residents to zero?
yea i guess the interest on that 6 figure loan isn't a big deal or anything. just work 100 hours a week for free for a few years while taking out more loans just to be able to pay rent and buy ramen, you have the rest of your life to pay those loans back anyway.

 

[Juicec]

Its great someone is thinking, however I don't see it ever happening :S With $20k+ in interest every year from medical school debt alone it is unlikely anyone would vouch for $0 income for the 3-6 years of residency for some specialties. I don't have the right answer by any means but I don't see this being the right path either.

 

[CodeBlu]

Cut residents salaries to zero? ahahahahaha

 

[UrshumMurshum]

It depends where you're at. It doesn't have to entail cutting everyone's salary, but at least give a certain amount of slots at no salary. It's highly likely people would rather go into an unpaid residency slot and then be able to be a radiologist than not having that option available to them.

So maybe retain the paid specialty slots, and leave those for the highly competitive residents, but then at least give an option for unpaid residency slots for those who aren't as competitive but want to get into that field. That way you can still get the added benefit of adding more slots.

 

[equinsu ocha]

Cut residents salaries to zero? ahahahahaha

You laugh, which contributes nothing to the problem, at an idea with potential. Cutting all the way to zero is obviously a bit too extreme, but what's the problem with increasing primary care and decreasing specialist salary by a more reasonable amount? You add incentive without needing more funding, just as the op said. Codeblu you seem like an intelligent person with vast experience, maybe you could contribute something without wasting everyone's time, including your own, with condescending replies.

 

[IlDestriero]

It depends where you're at. It doesn't have to entail cutting everyone's salary, but at least give a certain amount of slots at no salary. It's highly likely people would rather go into an unpaid residency slot and then be able to be a radiologist than not having that option available to them.

So maybe retain the paid specialty slots, and leave those for the highly competitive residents, but then at least give an option for unpaid residency slots for those who aren't as competitive but want to get into that field. That way you can still get the added benefit of adding more slots.

Just what we need, lower quality subspecialists who will charge more and not take medicaid patients to make up for their extra 2-300k of debt.
That's the answer!
BTW, if you offer someone the choice between x and going 200k more in debt now but making x+200k a year for 30+ years, it's not going to do much to drive people into FP. Total gov't reform might, but that's not realistic any time soon.

 

[IlDestriero]

You laugh, which contributes nothing to the problem, at an idea with potential. Cutting all the way to zero is obviously a bit too extreme, but what's the problem with increasing primary care and decreasing specialist salary by a more reasonable amount? You add incentive without needing more funding, just as the op said. Codeblu you seem like an intelligent person with vast experience, maybe you could contribute something without wasting everyone's time, including your own, with condescending replies.

I like your condescending replies. Great minds think alike.

 

[equinsu ocha]

I like your condescending replies. Great minds think alike.

What?

 

[Morsetlis]

Raise Medicare reimbursement...

But wait! We don't have money!

Increase residency slots...

But wait! We don't have money!

****.

 

[CodeBlu]

I like your condescending replies. Great minds think alike.

Since apparently I'm a condescending jerk, I might as well try and illustrate my condescension and paint the rainbow 87 shades of stupid.

Medical school costs on average $40,000 a year in tuition. X4
Living expenses (including food, rent etc), a car, a stethoscope, step I/II prep materials et al. will prob run close to $80-100K

We're at $260,000 already...

As a resident physician you work ungodly hours and get paid a measly wage. For example, you will work an 80 hour work week, with night call. Some general surgery residencies make you take 1 in 3 call... which means... basically your life is non-existent and you hate people. Thus, you become a misanthropic SOB (and no, that does not stand for shortness of breath). So, excuse me for thinking that 60K a year for a PGY-1 is not too much to ask, considering the attending is getting the resident to do most if not ALL of the leg work. Notice how someone with ~250K in debt won't be able to really make payments on that loan?

Why? Cuz you gotta live somewhere right? You gotta have internet? Drive something? Put food in your mouth? By the time you get through with paying all of that, you have maybe 10-15K left to spend on something other than ramen noodles... and you want to tell me to cut the residents salary to zero?

So imagine having to take out loans after medical school for 3-7 years depending on your residency program, so that for 11 years of your life you can live as an indentured servant, or slave I should say... while you're dodging money grubbing ambulance chasing lawyers who would have your head on a stick. Maybe I'm asking too much... then again... what do I know? It's not like I've seen/heard all of this first hand.

Excuse me for being a condescending dbag, when I think that residents are underpaid, overworked SLAVES. At least there is the prospect of making 200K+ following the PGY1-PGY??? years.

 

[equinsu ocha]

just what we need, lower quality subspecialists who will charge more and not take medicaid patients to make up for their extra 2-300k of debt.
That's the answer!
Btw, if you offer someone the choice between x and going 200k more in debt now but making x+200k a year for 30+ years, it's not going to do much to drive people into fp. Total gov't reform might, but that's not realistic any time soon.

Exactly, so maybe we should think on a smaller scale. You say it won't do much but it could help? Not everyone thinks long term. Its just irritating to see someone put out an idea and have others shoot it down and contribute nothing. But hey, let's just continue to b**** about the problem and insult each other..

 

[NickNaylor]

For smart people, a salary of $70k for three years vs. no salary for however long the residency of X specialty is probably not worth a lifetime salary of ~$160k for family practice vs. $250k+ for other specialists, and significantly more depending on the field. This idea would probably work for people that are very short-sighted but not for those that have the capacity to think more than three years down the road.

 

[PantherPride]

Now for specialty residency slots, since these students will presumably go on to make 2-3 times that of a family practice physician in the private sector, I think it's reasonable to cut the salaries of specialty residencies to zero.

 

[45408]

What a stupid idea. You really think I should work for five or six years with no income (and no source of loan money) after I'm already over $150K in debt?

How exactly do you think my bills will be paid? I'm not a student, so I don't get student loans. I'm sure my family would love to live under a bridge with me in cardboard boxes. That will make me into a much better surgeon.

Seriously, the inane ideas you guys come up with in this forum blow my mind.

 

[ppfizenm]

Well I guess we've found the Paul Ryan of medical students. But you're plan does nothing to address the overall physician shortage problem, not to that it is a feasible plan anyway. Shuttling physicians into family practice wont decrease the shortage. We will still be 90,000 physicians short. Not to mention there are only a certain number of family practice residency spots that are filled each year. In all your plan would only increase competition for those residencies. Not increase the number. The only thing that will so that is increase funding for residencies so we can add more spots and start accepting more people into med school.

 

[235788]

How about the DO's pick up the slack. The philosophy of osteopathic medicine revolves around developing the ultimate family care physician. Hence the reason why I pursue an MD rather then a DO. Also, give NP's (noctors) the opportunity to complete a 3 year fam medicine residency to fill the void in rural areas - but nothing else!!!



Also, Call me crazy, but I've yet to really buy the whole physician shortage story. They said the same thing about Pharmacists, and now there is a surplus. A fair amount of pharmacy students at my school are having trouble finding jobs in populated areas; forcing them to go rural or travel for work. I sense we will eventually start overproducing physicians and the overall quality and competency of physicians will decrease. Look at cRNA's they have saturated the market and their job security has gone (or heading) down the toilet.

 

[maybemed2013]

More PAs and nurses...there was a nurse shortage and it been fixed by replacing nurses with cnas and medical assistants.

 

[UrshumMurshum]

TheProwler you still have to admit there would most likely be people who aren't competitive enough coming out of medical school to get into a specialty slot who would choose an unpaid specialty spot if it meant they could get into the specialty they wanted.

I don't think it would dilute the specialty significantly, there are already many highly qualified medical students who're just faced with too tight a window for things like radiology or derm.

And yes, residency would suck, but thinking long term if you come out making $300,000 it would only realistically take 3 years tops to pay off accumulated debt.

Obviously something would need to be done to cover living expenses in the absence of student loans.

Realistically residency funding needs to increase, that would be ideal of course. Especially since even a measly 2 billion/year would proportionally raise enough residency slots to cover the shortage.

 

[235788]

TheProwler you still have to admit there would most likely be people who aren't competitive enough coming out of medical school to get into a specialty slot who would choose an unpaid specialty spot if it meant they could get into the specialty they wanted.

I don't think it would dilute the specialty significantly, there are already many highly qualified medical students who're just faced with too tight a window for things like radiology or derm.

And yes, residency would suck, but thinking long term if you come out making $300,000 it would only realistically take 3 years tops to pay off accumulated debt.

Obviously something would need to be done to cover living expenses in the absence of student loans.

Realistically residency funding needs to increase, that would be ideal of course. Especially since even a measly 2 billion/year would proportionally raise enough residency slots to cover the shortage.

Agree. People know what they want to become and will not let debt get in their way. I'll gladly take the hit in order to one day be a urologist.

 

[phltz]

Now for specialty residency slots, since these students will presumably go on to make 2-3 times that of a family practice physician in the private sector, I think it's reasonable to cut the salaries of specialty residencies to zero. Therefore, this should accomplish two things, one it should provide enough funding to boost family practice residency salaries, and it should also allow teaching hospitals to boost the number of slots.

Cutting to zero seems excessively harsh. But to everyone who's jumping down OP's throat, try to look at this from more than just the point of view that furthers your own narrow interests. Highly qualified M4s are beating down the doors to pretty much every ROAD residency out there, and hordes of them are turned away every year. Meanwhile, the number of unfilled family practice residency slots exceeds 100 every year, and sometimes exceeds 200. Now, if you believe in the free market (and most of you bitching and moaning about this proposal are the same people I always see in these forums complaining about how the government is undermining the free market in health care), the appropriate response to a situation where there is an oversupply of wannabe ROAD residents and an undersupply of wannabe Family Medicine residents is to improve the compensation package of FM as compared to the ROADs.

This is fundamental economics here, people. When supply exceeds demand, the only normal response is for the price to drop. When demand exceeds supply, the only normal response is for the price to rise. If you just don't want to see your expected future salary go down, fine, rail against such a proposal. Just don't try to paint it as anything other than pure selfishness.

 

[CodeBlu]

Agree. People know what they want to become and will not let debt get in their way. I'll gladly take the hit in order to one day be a urologist.

Sure, but will your family?

You say this now, but when you need to fix your car, and it costs $5000, and you need to pay taxes, health insurance... you'd want to have money no?

You're all saying, you'd be happy with making $0 until you're 30-32 years old....

No one ever said go into medicine for the money, but there's nothing wrong with getting paid to do what you love.

 

[Gigantron]

How about lower or completely eliminate medical school tuition for those who are committed to a primary care specialty from day one? I've heard about incentive programs like these before with a select few schools.

Cutting specialty resident salaries is absolutely ludicrous. No neurosurgery resident (just an example) is going to work 6-7 years of their life with possibly 200k+ in debt when they won't even be compensated for it more than half a decade later. That would only make shortages in these specialties (like Neurosurgery) more prominent.

I'm just glad none of these ideas are EVER going to happen, though. 🙂

EDIT: What I see in this thread: Idealistic pre-meds with little financial sense, who want to be physicians ONLY because they like science and helping people, saying that they would be happy making $0 for 2-7 years after medical school.

 

[235788]

I think a realistic solution besides the one i previously posted would be to offer 0% interest of loans if you enroll in fam med, or perhaps even an partial loan forgiveness (100k?)

 

[Bacchus]

Cut residents salaries to zero? ahahahahaha

You laugh, but there's some thought somewhere (sorry I can't be specific) of allocating funds for 100% paid for medical education and having MDs and DOs pay for residency training by the year with the hope more people will take on less debt and go into the primary care specialties.

I've had 2 attendings mention this to me. I haven't looked for any sources regarding it.

 

[Bacchus]

How about the DO's pick up the slack. The philosophy of osteopathic medicine revolves around developing the ultimate family care physician. Hence the reason why I pursue an MD rather then a DO. Also, give NP's (noctors) the opportunity to complete a 3 year fam medicine residency to fill the void in rural areas - but nothing else!!!



Also, Call me crazy, but I've yet to really buy the whole physician shortage story. They said the same thing about Pharmacists, and now there is a surplus. A fair amount of pharmacy students at my school are having trouble finding jobs in populated areas; forcing them to go rural or travel for work. I sense we will eventually start overproducing physicians and the overall quality and competency of physicians will decrease. Look at cRNA's they have saturated the market and their job security has gone (or heading) down the toilet.

I hope you're trolling but I don't think that is the case.

 

[gravitywave]

How about the DO's pick up the slack. The philosophy of osteopathic medicine revolves around developing the ultimate family care physician. Hence the reason why I pursue an MD rather then a DO. Also, give NP's (noctors) the opportunity to complete a 3 year fam medicine residency to fill the void in rural areas - but nothing else!!!

despite your total lack of understanding behind the DO philosophy, DOs already are doing this to a certain extent by participating in the allo Match in increasing numbers and matching disproportionally into primary care slots when they do so. but that won't do anything to help the shortage if the number of slots isn't expanded/reallocated.

NPs aren't going to want the FM residency option: they aren't trained for it, and many wouldn't be able to pass the exams. Why would they do that when they can do what they do now for far less bother?

Also, Call me crazy, but I've yet to really buy the whole physician shortage story. They said the same thing about Pharmacists, and now there is a surplus. A fair amount of pharmacy students at my school are having trouble finding jobs in populated areas; forcing them to go rural or travel for work. I sense we will eventually start overproducing physicians and the overall quality and competency of physicians will decrease. Look at cRNA's they have saturated the market and their job security has gone (or heading) down the toilet.

i'm not convinced they have the numbers right either, but there are two major issues going forward that practically guarantee a lower physician/patient ratio:
1) baby boom is retiring. that takes doctors out of the workforce at the same time that a third of the population is going to need more healthcare.
2) expanding coverage under the new health care law. more people will be insured, so more will be seeking services, particularly from primary care folks.

 

[gravitywave]

How about lower or completely eliminate medical school tuition for those who are committed to a primary care specialty from day one? I've heard about incentive programs like these before with a select few schools.

these programs already exist at the state and federal level for students at any US school. the issue is that very few students are committed in the manner you describe, nor will they be until the incentives at the distant end start to change.

even if you don't take advantage of these programs, jobs for new FM attendings typically include $50k+ loan repayment programs on top of competitive salaries. FM isn't as raw a deal as many on SDN think, especially once you consider the lifestyle.

 

[UrshumMurshum]

EDIT: What I see in this thread: Idealistic pre-meds with little financial sense, who want to be physicians ONLY because they like science and helping people, saying that they would be happy making $0 for 2-7 years after medical school.

No, the point of this thread was to address the physician shortage. No candidate is talking about the supply side of health care. In Texas alone with recent medicare cuts the Texas Medical Association is projecting that as much as 55% of Texas physicians will begin rejecting medicare patients.

You need to get out of the mindset that we're in a climate where the medical field is saturated in supply. If you don't think the physician shortage is a big enough problem to make drastic changes then yes making changes to the system would appear ******ed. But in my opinion the physician shortage is a large problem and if changes aren't implemented to the system it will lead to many people receiving inadequate medical care.

Another good idea was floated in this thread and that was to look at giving physician assistants and NP training programs to perhaps become equally qualified as family practice physicians. This could alleviate family practice shortages and allocate the funding towards specialty residencies that can't be easily filled by NP and Assistants, thus attacking both issues of the physician shortage.

 

[equinsu ocha]

Another good idea was floated in this thread and that was to look at giving physician assistants and NP training programs to perhaps become equally qualified as family practice physicians. This could alleviate family practice shortages and allocate the funding towards specialty residencies that can't be easily filled by NP and Assistants, thus attacking both issues of the physician shortage.

It's called medical school.

 

[mishaS]

There will soon be a huge influx of medical students both from new schools, and established schools increasing their class sizes. An easier solution would be to concentrate new residency slot funding in family medicine.

Better yet, why not let NPs and PAs pick up the slack more. They are more than trained enough to do the vast majority of family practice work. If you have a single general practitioner overseeing 3,4,5, or however many NPs and PAs, and there to confirm diagnoses, that would alleviate a lot of the shortage.

 

[kpcrew]

And yes, residency would suck, but thinking long term if you come out making $300,000 it would only realistically take 3 years tops to pay off accumulated debt.

i'm not sure you understand how this all works.
it's not "earn $300k and use it all to pay down debt in 3 years". it's more like have an income of 300k and have the federal government take 1/3 and your local governments another 1/6 or so. then you have to pay for your mortgage or rent and car payments. food, utilities, maybe you own a pet, other expenses, clothing, etc. god forbid you have to take care of a child or your parents during that period. i believe doctors also have to pay for their own insurance but i'm not sure about that. then maybe after a few years as an attending, you're finally in the black. congratulations! you finally paid off all of your debt! and you're only 40 years old.

 

[alexandertg6]

i'm not sure you understand how this all works.
it's not "earn $300k and use it all to pay down debt in 3 years". it's more like have an income of 300k and have the federal government take 1/3 and your local governments another 1/6 or so. then you have to pay for your mortgage or rent and car payments. food, utilities, maybe you own a pet, other expenses, clothing, etc. god forbid you have to take care of a child or your parents during that period. i believe doctors also have to pay for their own insurance but i'm not sure about that. then maybe after a few years as an attending, you're finally in the black. congratulations! you finally paid off all of your debt! and you're only 40 years old.

this. x10,000. Yes for the OP, it is a great idea for solving the shortage of family practice physicians. The problem is that it will do so by killing the number of people who go on to specialize, and the US will have an across the board shortage in every specialty within 5 years or so.... as TheProwler stated, if things worked that way very few people would be financially capable of specializing.

 

[NickNaylor]

this. x10,000. Yes for the OP, it is a great idea for solving the shortage of family practice physicians. The problem is that it will do so by killing the number of people who go on to specialize, and the US will have an across the board shortage in every specialty within 5 years or so.... as TheProwler stated, if things worked that way very few people would be financially capable of specializing.

But it doesn't even do that because the number of residency applications (NOT the number of people entering that specialty) is the bottleneck. In other words, unless you increase the number of residency positions (which requires more funding), the physician shortage won't be addressed.

 

[lkthlttr]

i'm not sure you understand how this all works.
it's not "earn $300k and use it all to pay down debt in 3 years". it's more like have an income of 300k and have the federal government take 1/3 and your local governments another 1/6 or so. then you have to pay for your mortgage or rent and car payments. food, utilities, maybe you own a pet, other expenses, clothing, etc. god forbid you have to take care of a child or your parents during that period. i believe doctors also have to pay for their own insurance but i'm not sure about that. then maybe after a few years as an attending, you're finally in the black. congratulations! you finally paid off all of your debt! and you're only 40 years old.

And that is assuming you start when you're 22.

 

[kpcrew]

And that is assuming you start when you're 22.

yeah i wrote "if you started right after college" but i think i edited that out by accident.

 

[Barcu]

Also, Call me crazy, but I've yet to really buy the whole physician shortage story. They said the same thing about Pharmacists, and now there is a surplus. A fair amount of pharmacy students at my school are having trouble finding jobs in populated areas; forcing them to go rural or travel for work. I sense we will eventually start overproducing physicians and the overall quality and competency of physicians will decrease. Look at cRNA's they have saturated the market and their job security has gone (or heading) down the toilet.

Well, like you said about pharmacists, there really isn't a physician shortage (nor will there probably ever be) in large populated areas. It is the underserved populations in cities and especially in rural environments where the physician shortage is really being felt. Working at a one of these clinics, I can attest to how much they rely on mid-levels and medical assistants.

I think a realistic solution besides the one i previously posted would be to offer 0% interest of loans if you enroll in fam med, or perhaps even an partial loan forgiveness (100k?)

They already have these at some schools and through the government after graduation.

This whole pay-scale residency issue does raise an interesting solution, but it is one that isn't really fair and is pretty unrealistic.

The major problem is the type of people recruited to med schools (who tend to be rich and white). You can already find loan forgiveness programs and significantly higher salaries in rural areas already. Frankly, current medical school grads just don't want to go there, which is pretty much solely for non-financial reasons. So changing the pay-scale may or may not have a huge effect, as it is not always the important factor we make it out to be.

The real way to make major changes is to recruit students who want to work in those areas, and many schools have started up programs to do so. I guess we'll see if they work out.

 

[alexandertg6]

But it doesn't even do that because the number of residency applications (NOT the number of people entering that specialty) is the bottleneck. In other words, unless you increase the number of residency positions (which requires more funding), the physician shortage won't be addressed.

+1 I agree completely, which is why trying to pressure current numbers into primary care is not going to solve the problem. Changing the proportions of the pie chart does not make the pie big enough to feed everyone.

 

[Jack is Back]

But it doesn't even do that because the number of residency applications (NOT the number of people entering that specialty) is the bottleneck. In other words, unless you increase the number of residency positions (which requires more funding), the physician shortage won't be addressed.

correct.

Need more slots. More med students doesn't even help, unless we plan on driving out all the IMGs, but still the slot problem exists.

 

[phltz]

correct.

Need more slots. More med students doesn't even help, unless we plan on driving out all the IMGs, but still the slot problem exists.

FM never fills all their slots. So improving the incentives on FM slightly could be expected to cause fewer slots to be left unfilled, and thus improve the situation. The more competitive specialties, on the other hand, typically fill almost all of their slots, with a surplus of qualified applicants. Making the incentives a little better or worse would not likely change the number of trained specialists leaving these residency programs.

 

[phltz]

But it doesn't even do that because the number of residency applications (NOT the number of people entering that specialty) is the bottleneck. In other words, unless you increase the number of residency positions (which requires more funding), the physician shortage won't be addressed.

There are other strategies that could also relieve the shortage. Many of the simple procedures that are currently performed by physicians could easily be done by trained technicians, freeing up more physician time to care for patients in ways that actually require extensive training and a broad base of knowledge. Physicians don't develop x-rays, dispense pills, or do a lot of other low-level grunt work, because it's a waste of their time and skills to do that when there's other stuff that needs to be done. It's ridiculous that physicians are still, say, freezing warts off with liquid nitrogen.

The only reason this happens is because it's lucrative and physicians have fought to keep all the lucrative procedures. The only reason that it's so lucrative is that physicians have a legal monopoly on doing this. It's rent-seeking at its purest and worst. It's a mystery to me why more physicians of good conscience don't speak out against this sort of stuff.

 

[thepoopologist]

Cede the middle of the US to Canada.

 

[Morsetlis]

Canadians aren't interested in your lumberjack- and ice-free lands.

 

[BirdIsTheWord]

You are proposing this with the idea that FM physicians have a problem making 160k. If these physicians wanted to make more, then they would have gone into another specialty, but they wanted to do FM and I'm sure they knew the things that came with it

 

[gettheleadout]

You are proposing this with the idea that FM physicians have a problem making 160k. If these physicians wanted to make more, then they would have gone into another specialty, but they wanted to do FM and I'm sure they knew the things that came with it

Or they couldn't match into anything else.

 

[CodeBlu]

Or they couldn't match into anything else.

Unfortunately... this is most likely the case. However, family medicine can be very lucrative and rewarding if done in a certain way.

 

[235788]

Unfortunately... this is most likely the case. However, family medicine can be very lucrative and rewarding if done in a certain way.

They still make solid money. I do feel with the way things are going reimbursement wise that they just wont be able to have their own office and will continue to get sucked into super health care systems that are ran on metrics rather then care (Ex. ohio health)- which would kind of suck.

 

[235788]

Well, like you said about pharmacists, there really isn't a physician shortage (nor will there probably ever be) in large populated areas. It is the underserved populations in cities and especially in rural environments where the physician shortage is really being felt. Working at a one of these clinics, I can attest to how much they rely on mid-levels and medical assistants.



They already have these at some schools and through the government after graduation.

This whole pay-scale residency issue does raise an interesting solution, but it is one that isn't really fair and is pretty unrealistic.

The major problem is the type of people recruited to med schools (who tend to be rich and white). You can already find loan forgiveness programs and significantly higher salaries in rural areas already. Frankly, current medical school grads just don't want to go there, which is pretty much solely for non-financial reasons. So changing the pay-scale may or may not have a huge effect, as it is not always the important factor we make it out to be.

The real way to make major changes is to recruit students who want to work in those areas, and many schools have started up programs to do so. I guess we'll see if they work out.

Yeah, but who is to say what students will actually do. I think the thing that Ohio University does that makes out of state students sign a contract that requires them to practice in the state of ohio. Perhaps a legal binding contract?

 

[Barcu]

Yeah, but who is to say what students will actually do. I think the thing that Ohio University does that makes out of state students sign a contract that requires them to practice in the state of ohio. Perhaps a legal binding contract?

Very true, and it would be difficult. There are really no guarantees. It could require a contract (like the military, National Health Service, etc). Or, you just recruit the best you can and hope it works out, which is part of the rational behind URMs as well (as in to get doctors who will work in certain areas). It doesn't always work out, but it could help the problem.

 

[thesauce]

For smart people, a salary of $70k for three years vs. no salary for however long the residency of X specialty is probably not worth a lifetime salary of ~$160k for family practice vs. $250k+ for other specialists, and significantly more depending on the field. This idea would probably work for people that are very short-sighted but not for those that have the capacity to think more than three years down the road.

This. OP: do you really think 45,000 more people are going to go into FP just because you offer them another $10-20k/yr? That might cause one to choose one program over another but not one specialty over another.