I don't think it's the answer, either. Not the whole answer, anyway.
Increasing primary care residency positions is a great idea, but won't do much good unless there are people who want to fill them.
The gap between primary care and specialty incomes will have to narrow for more people to want to pursue primary care careers, especially in the face of rising student debt (another problem without an easy solution).
http://futureoffamilymedicine.blogspot.com/2012/07/primary-care-subspecialist-physician.html
https://twitter.com/AAFP_FMIG/status/222747238802259968
I think this is a very complicated situation.
-Either increase primary care residency spots, which would mean more gov. funding for resident salaries
-Make medical education free or mostly subsidized by the gov, a la Canada and other countries where healthcare is free
-Increase midlevels and have them work under the supervision of a PCP - sadly, I do think this is a cost effective measure, that will inevitably be put in place. Why? Well, for many visits, midlevels can likely take care of the patient's needs, and for more complex issues, an actual doc could take care of serious matters. My husband went to see a FM doc the other day. Husband is young, just wanted a physical and to get his immunizations in order. Insurance got charged about 200$. A midlevel could have taken care of his needs for much cheaper. I think for millions of visit, this scenario is much more cost efficient. Increasing the # of residency spots unfortunately would be $$$, and increasing PCP salaries again-becomes expensive.
PCPs on avg make 200k, which imo is not bad at all. But let's say we want to increase their pay-what do we increase to? 250k? 300k? Then they are making about the same as specialists, and the goal is to cut specialist pay. So we are back at square one, are we not? Clearly there is a bigger need for PCPs than there is for specialists. Can the system handle PCPs making 300K? Not realistically. Serious increase in PCP pay would mean the collapse of the system. And what happens when people say hey, I can be a hospitalist or a FM doc for 300k, so I'll just forego the 3-4+ extra years of training to become a PCP. Then we have a situation where we have a shortage of specialists. Then specialist salaries have to rise again to attract grads.
I think the only way to make this work if you want doctors to work for less is to make medical education nearly free, make serious tort reform so that practitioners are not constantly ordering things in order to save their butts in case something goes wrong, and in the case of primary care, I unfortunately think that a higher midlevel introduction with PCP docs taking more of a supervisory role makes a great deal of sense.
An example: Rad oncs avg is in the 350/400k let's say, but there are not even 200 rad oncs that graduate yearly. The system can take 178 or so people making that kind of money, but the system would collapse if it had all 6,000 or however many IM/FM grads yearly (i don't know exactly how many residency positions there are in those fields, sorry) making 300-350k/year. There would be a complete and total collapse of the system.
Also, you look at something like derm where on the chart it shows that the increase in $ has grown significantly. But you also have to realize that a lot of the derm practice is cash based, part of it is cosmetics based (so it's not a cost to the gov/taxpayers), and part of it is also that derms can see many more patients than a PCP/other specialist due to the nature of the specialty, so I think the chart is a bit biased. If you take into account the # of patients seen per avg by a derm vs. a PCP, I would imagine that the costs would be similar. For example when I was rotating in derm I had one attending who would see 50 patients a day. A PCP clearly cannot do that, so the $$ that is brought in per day is much less.
