PCP shortage

[hoops90]

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If there is a nationwide shortage of PCPs, couldn't medical schools just create additional seats in entering classes, in which the persons who fill those additional seats must enter a primary care specialty?

 

[FutureDrB]

Additional seats are not the issue. The problem is that there are a dwindling number of applicants interested in going into primary care. (This is due to a number of reasons.)

Check the residency figures...there no problem landing a pc residency spot if you want one.

 

[Drrrrrr. Celty]

It's because not enough people want to incur 200k+ debt from medical school and undergraduate education to pursue a low paying specialty with call and long hours. Not to mention for many the specialties are probably generally unappealing to many personalities.

 

[Iliketoytles]

Not gonna lie, I thought this would be about a drug shortage. I'm not interested anymore...

Kidding, but the above posters are right... there's just no incentive to go into primary care. They could provide more scholarships, but that requires money... which, rumor has it, doesn't grow on trees.

 

[IDFsoldierboy]

Not gonna lie, I thought this would be about a drug shortage. I'm not interested anymore...

Kidding, but the above posters are right... there's just no incentive to go into primary care. They could provide more scholarships, but that requires money... which, rumor has it, doesn't grow on trees.

you mean you never heard of the money tree?! its native to washington dc...grows like crazy over there

 

[Cornell08]

The previous posters are right, I've heard the figure that the nation needs medical students going into PC at a 70/30 ratio and what we now have is 30/70. As osteopathic medical students/applicants, you surely understand the important of preventative medicine and how it saves lives, pain, and lots of money for patients, insurance companies, the government, and the economy. With this in mind, I think the best answer is some sort of less restrictive version of the National Health Service Corps where maybe you receive X dollars for going into primary care toward your student loans-- right now the incentives are all screwed up. With medical school as expensive as it is it is only rational to consider specializing even for those applicants who could see themselves loving primary care fields.

 

[Cornell08]

To further elaborate, if the government were to pay 150k toward the student debt of 10,000 medical school graduates per year (out of approximately 20,000 US MD/DO grads) it would cost 1.5 billion dollars to fund such a program. I think such a program would end up saving a great deal more than 1.5 billion a year in health savings-- thoughts?

 

[hoops90]

I know the NHSC has the Loan Repayment Program (complete 6 years of service in a HPSA, and then your undergraduate and medical student loans are payed for). It may be 5 years of service. I'll have to check again.

 

[Drrrrrr. Celty]

To further elaborate, if the government were to pay 150k toward the student debt of 10,000 medical school graduates per year (out of approximately 20,000 US MD/DO grads) it would cost 1.5 billion dollars to fund such a program. I think such a program would end up saving a great deal more than 1.5 billion a year in health savings-- thoughts?

It's an interesting solution, I don't know if many MD/DO's are still incredibly interested in primary care though. Why do IM or FM when you could have a 9-5 job in lush even non-competitive residencies like PM&R or Psych.

 

[poopyhead]

There doesn't really need to be scholarships or tuition reimbursement when there are so many qualified applicants as it is. If 70/30 is what's needed, then the schools can simply reserve 70% of all seats for PCP only by contract with the incoming students.

 

[Cornell08]

Hey Hoops, I'm aware of both the scholarship and the loan repayment programs through the NHSC (I think it's 6 years for complete repayment). I've begun looking into it but there are a lot of drawbacks-- the program seems pretty inflexible and who wants to get stuck in a bad situation for 6 years? If you accept NHSC money, at least for the scholarship, and try to quit then you owe 3X plus interest of what they gave you so there's no tenable "out". I imagine by the time I finish my residency I'll be married-- what if my spouse can't get a job in rural Wyoming or wherever? I realize those areas need physicians badly but so do other areas. What I am suggesting is a much more straightforward and less bureaucratic solution.

Right now with the system we have, the real winners are the banks who loan money at 4-8 percent to med students who then sit on those loans for 7 years accruing interest in a time when there's between 0-2 percent inflation. Do the math and they're making a fantastic profit and easy money. I don't want this to turn into an Occupy SDN thread but the bottom line is that these costs (the high cost of borrowing money and funding a med school tuition) gets passed on to the customers. It's the same argument I give to people who are gung ho about suing the pants off "rich" doctors in often frivolous malpractice suits-- if it costs 100k a year to insure an OB/GYN then every dollar of that cost is going to get passed along to the customer.

 

[Cornell08]

There doesn't really need to be scholarships or tuition reimbursement when there are so many qualified applicants as it is. If 70/30 is what's needed, then the schools can simply reserve 70% of all seats for PCP only by contract with the incoming students.

It's an option but I don't think coercing students to go into primary care who don't want to take out 250k-300k in debt is going to work. If you look at the numbers for DO schools which have traditionally been bastions for primary care, DO graduates in the last 15 years have become far less likely to go into primary care. I find it hard to believe that primary care has become any more or less inherently desirable...I think students make a pragmatic decision that with medical school rising at far higher rates than inflation for god knows how long, that they need to go into a specialty to pay off their debt in a reasonable amount of time.

Another option is to have 3 years of medical school for primary care physicians which is a pathway that LECOM and a few other schools have begun-- figure between tuition savings and an extra year of practicing (opportunity cost for anyone who has taken econ) that extra year can save you between 150k-250k depending on your initial earnings and the cost of tuition.

 

[TriagePreMed]

Medical School costs an arm and a leg. There's no surprise that people are turning away from specialties that pay like garbage and require working like mule.

 

[Drrrrrr. Celty]

There doesn't really need to be scholarships or tuition reimbursement when there are so many qualified applicants as it is. If 70/30 is what's needed, then the schools can simply reserve 70% of all seats for PCP only by contract with the incoming students.

It hurts to know that someone will have a doctor with a logical process like you. Sorry, your plan is stupid and insulting to my ego. I hope you feel very bad man...


On a more serious note: I don't think it's fair to sequester people who have never even experienced that particular area of specialization, into that area without their informed consent after 3rd year at least. If you're on this contract and you later find out oh, I like {insert specialty} better, then you're screwed and going to be an unhappy and thus likely to be a ****ty physician who will likely jump off a building.

 

[deleted435584]

There doesn't really need to be scholarships or tuition reimbursement when there are so many qualified applicants as it is. If 70/30 is what's needed, then the schools can simply reserve 70% of all seats for PCP only by contract with the incoming students.

It's illegal to force people to do st. they don't like.

 

[FrkyBgStok]

I think they need to recruit more in rural areas and hope people go back to rural areas. How are you going to add seats and force those people to do primary care?

 

[Drrrrrr. Celty]

I think they need to recruit more in rural areas and hope people go back to rural areas. How are you going to add seats and force those people to do primary care?

Probably not a high yield endeavor though.. They might be better off increasing reimbursement rates in rural areas for primary care doctors. I think that'll combined with fresh air will compensate for being in a rural area .
Also, again. Why force people to do something they potentially might not like? It breeds unhappiness and the fact is an unhappy physician will not be as efficient or interested in his world as a happy physician who likes the field he's chosen.

 

[deleted212936]

I think they need to recruit more in rural areas and hope people go back to rural areas.

Actually, studies show that health professionals (doctors, pharmacists, PA, nurses,etc.) tend to stay close to where they were trained.

 

[poopyhead]

It hurts to know that someone will have a doctor with a logical process like you. Sorry, your plan is stupid and insulting to my ego. I hope you feel very bad man...


On a more serious note: I don't think it's fair to sequester people who have never even experienced that particular area of specialization, into that area without their informed consent after 3rd year at least. If you're on this contract and you later find out oh, I like {insert specialty} better, then you're screwed and going to be an unhappy and thus likely to be a ****ty physician who will likely jump off a building.

It's illegal to force people to do st. they don't like.

sigh....there's no force involved. The contract doesn't just get sprung during clinicals. The contract would be signed before the person even started med school. Some seats would be with the PCP contract; some seats without the PCP contract. If applicants didn't want to sign the contract, they can apply for the non-PCP seats. This is essentially the same type of contract that OU makes OOS applicants sign to work in Ohio for five years.

btw serenade, I was speaking from the schools' point of view. Why would they need to provide financial incentives when there are more than enough qualified applicants who will sign the PCP contract.

In the end, this is all moot. By recklessly expanding/increasing schools, more american graduates will be "forced" into PCP anyways.

 

[MT Headed]

Some states help their students with tuition, and then require the students to return for a few years of primary care as payback. Montana used to do that too, and as you all suspected it generated disgruntled doctors and poor patient experiences. Now Montana has the Montana Rural Physician Incentive Program and the state basically pays $100,000 extra to any doctor over the first five years of practice here.

I am genuinely curious how much of the lack of PCP providers is becacuse of the low pay vs. it being seen as a lousy line of work. I.e. are there perhaps students who would love to practice primary care but simply can't afford to?

 

[FrkyBgStok]

Actually, studies show that health professionals (doctors, pharmacists, PA, nurses,etc.) tend to stay close to where they were trained.

I can see the argument, but here in Iowa we talk about how the weather sucks, there is nothing to do, yet none of us would rather be anywhere in the world. If you would recruit in high school about the need for medicine in rural areas, and recruit from rural based community colleges to go into medicine. Maybe even offer more scholarships for people coming from rural areas. Not saying it will work for everyone, but it might. Maybe I am being naive, but I cam see the positives.

 

[DrBowtie]

Hey Hoops, I'm aware of both the scholarship and the loan repayment programs through the NHSC (I think it's 6 years for complete repayment). I've begun looking into it but there are a lot of drawbacks-- the program seems pretty inflexible and who wants to get stuck in a bad situation for 6 years? If you accept NHSC money, at least for the scholarship, and try to quit then you owe 3X plus interest of what they gave you so there's no tenable "out". I imagine by the time I finish my residency I'll be married-- what if my spouse can't get a job in rural Wyoming or wherever? I realize those areas need physicians badly but so do other areas. What I am suggesting is a much more straightforward and less bureaucratic solution.

Right now with the system we have, the real winners are the banks who loan money at 4-8 percent to med students who then sit on those loans for 7 years accruing interest in a time when there's between 0-2 percent inflation. Do the math and they're making a fantastic profit and easy money. I don't want this to turn into an Occupy SDN thread but the bottom line is that these costs (the high cost of borrowing money and funding a med school tuition) gets passed on to the customers. It's the same argument I give to people who are gung ho about suing the pants off "rich" doctors in often frivolous malpractice suits-- if it costs 100k a year to insure an OB/GYN then every dollar of that cost is going to get passed along to the customer.

If by banks you mean the Federal government, then yes they are raking in $$$ on the interest. Most (all?) medical schools use the Federal Direct Loans.

It wasn't too long ago that banks were competing to service these government backed loans with interest rate and origination fee deduction perks.

 

[Drrrrrr. Celty]

sigh....there's no force involved. The contract doesn't just get sprung during clinicals. The contract would be signed before the person even started med school. Some seats would be with the PCP contract; some seats without the PCP contract. If applicants didn't want to sign the contract, they can apply for the non-PCP seats. This is essentially the same type of contract that OU makes OOS applicants sign to work in Ohio for five years.
Yes, there is force. You either become a PCP or you don't match. Likewise you sign the contract, do a surgery rotation, find it as your calling and you're now blown forever.

btw serenade, I was speaking from the schools' point of view. Why would they need to provide financial incentives when there are more than enough qualified applicants who will sign the PCP contract.
... I don't think I even need a rebuttle to this... there are not enough qualified applicants who will sign the PCP contract. If anything all you will do is dilute the applicant pool and make substandard people apply. You're breeding out brilliance.


In the end, this is all moot. By recklessly expanding/increasing schools, more american graduates will be "forced" into PCP anyways.

Yes, they will. But they will have some solace in that it was their choice, an educated choice after actually knowing what the career entails.

Honestly, I'm going to just say that the reckless expansion of DO schools will lead to most DOs being PCP. Most MD and strong DO applicants will not feel any of this for a long while and if they do go into IM they can go for a fellowship with ease.

 

[Bacchus]

I think they need to recruit more in rural areas and hope people go back to rural areas. How are you going to add seats and force those people to do primary care?

I had to meet with a recruiter on a rural rotation. It was NBD, actually, but I just had to talk for her a bit and as an incentive got a Dunkin' gift card and movie passes. The attending I was with said I could probably also negotiate loan repayment if I was truly interested. We'll see how I feel in a few years, ha.

 

[Cornell08]

If by banks you mean the Federal government, then yes they are raking in $$$ on the interest. Most (all?) medical schools use the Federal Direct Loans.

It wasn't too long ago that banks were competing to service these government backed loans with interest rate and origination fee deduction perks.

I'm not too knowledgeable about student loans but it was my impression that for most student loans the money comes largely from private banks (with some govt. subsidies?) but the reason student loans are lower is that they are backed by the govt.

i found this here:http://febp.newamerica.net/background-analysis/federal-student-loan-guaranty-agencies

The federal government offers several types of student loans to promote higher education access. Most students receive these loans through the Federal Family Education Loan (FFEL) program, in which the federal government provides subsidies and insurance against default losses to for- and non-profit lenders to encourage them to make student loans. The insurance on FFEL loans is handled by guaranty agencies, which are public or private nonprofit entities that perform a number of functions within the FFEL program. These activities include:

 

[Drrrrrr. Celty]

I had to meet with a recruiter on a rural rotation. It was NBD, actually, but I just had to talk for her a bit and as an incentive got a Dunkin' gift card and movie passes. The attending I was with said I could probably also negotiate loan repayment if I was truly interested. We'll see how I feel in a few years, ha.

Is it easy to get a Gen surgeon/anesthesiologists job in a rural area? I'm asking because it kinda looks like you're going for Gas.

 

[poopyhead]

Yes, they will. But they will have some solace in that it was their choice, an educated choice after actually knowing what the career entails.

Honestly, I'm going to just say that the reckless expansion of DO schools will lead to most DOs being PCP. Most MD and strong DO applicants will not feel any of this for a long while and if they do go into IM they can go for a fellowship with ease.

It's not "forced" because applicants can choose to apply for the non-PCP contract seats only. Again, this would be before med school even starts, not right before residency matching. Sort of like I choose to limit my chances of acceptance by not applying to OU as OOS because I don't want to sign that five-year contract or to an awesome school like MSU due to its ridiculous OOS tuition.

Anyways, all of this is just hypothetical. I still think that given the stubbornly bad economy/high unemployment, there aren't many viable alternatives for biology majors that yields the same stability/rewards as physicians. I believe there will be enough qualified applicants who will sign the hypothetical PCP contract. Other healthcare fields are running into over-saturation issues, and getting a PhD in Biology just to be terminally stuck as a postdoc isn't that great. There's always industry, but competition is extremely fierce nowadays .

 

[DrBowtie]

I'm not too knowledgeable about student loans but it was my impression that for most student loans the money comes largely from private banks (with some govt. subsidies?) but the reason student loans are lower is that they are backed by the govt.

i found this here:http://febp.newamerica.net/background-analysis/federal-student-loan-guaranty-agencies

The federal government offers several types of student loans to promote higher education access. Most students receive these loans through the Federal Family Education Loan (FFEL) program, in which the federal government provides subsidies and insurance against default losses to for- and non-profit lenders to encourage them to make student loans. The insurance on FFEL loans is handled by guaranty agencies, which are public or private nonprofit entities that perform a number of functions within the FFEL program. These activities include:

Like most people throwing out Occupy tags, you aren't too knowledgeable yet chose to make inflammatory comments.

A) You link to a think tank with an agenda.
B) Many of those programs do not apply to GRADUATE LOANS.

You might want to start here: http://www.direct.ed.gov/

There USED to be private entities that would lend money with government backing and consolidations as low as 2% interest. Now that most schools use DIRECT lending, we're pretty much stuck with fixed 6.8% interest straight to Uncle Sam.

 

[Drrrrrr. Celty]

It's not "forced" because applicants can choose to apply for the non-PCP contract seats only. Again, this would be before med school even starts, not right before residency matching. Sort of like I choose to limit my chances of acceptance by not applying to OU as OOS because I don't want to sign that five-year contract or to an awesome school like MSU due to its ridiculous OOS tuition.
Can you please think for a minute? You're start thinking PC is perfect for you, but then boom, you're a 3rd year student who just completed a good rotation which changed your mind completely. What then? YOUREFORCEDTODOARESIDENCY unless you want to drop out, so basically you're stuck in a residency which you may not be happy about now that you know better.
People change their minds in medical school many times.

Anyways, all of this is just hypothetical. I still think that given the stubbornly bad economy/high unemployment, there aren't many viable alternatives for biology majors that yields the same stability/rewards as physicians. I believe there will be enough qualified applicants who will sign the hypothetical PCP contract. Other healthcare fields are running into over-saturation issues, and getting a PhD in Biology just to be terminally stuck as a postdoc isn't that great. There's always industry, but competition is extremely fierce nowadays .

You don't need to do the PhD route, there are plenty of alternatives, especially outside of biology. And if medical school became this, pretty much speaking you'll end up with biology majors being primarily pre-dents or pre-health. But yes, that's outside of the point.
I'll admit to you, that medicine has one major appeal to me. I have a lot of time to decide what I want to and what I can specialize in. If you were to force me into something, medicine would loose a lot of its appeal and I along with many others would not be interested in the field any longer.

 

[poopyhead]

Can you please think for a minute? You're start thinking PC is perfect for you, but then boom, you're a 3rd year student who just completed a good rotation which changed your mind completely. What then? YOUREFORCEDTODOARESIDENCY unless you want to drop out, so basically you're stuck in a residency which you may not be happy about now that you know better.

Those seats would be for applicants who are willing to make that commitment. Non-PCP seats would be for those who don't want to be restricted (i.e. you).

You don't need to do the PhD route, there are plenty of alternatives, especially outside of biology. And if medical school became this, pretty much speaking you'll end up with biology majors being primarily pre-dents or pre-health. But yes, that's outside of the point.
I'll admit to you, that medicine has one major appeal to me. I have a lot of time to decide what I want to and what I can specialize in. If you were to force me into something, medicine would loose a lot of its appeal and I along with many others would not be interested in the field any longer.

Dental school isn't easy to get into, and ironically most dentists become GPs anyways. Other healthcare fields are having issues. And, the current economic climate is making jobs hard to come by. Unemployment rate for recent college grads are pretty staggering. Finally, there's no force because you can apply to only the non-PCP spots.

Anyways, that's it for me. Adding new schools/expanding class sizes will end up achieving the same results. GL on your application next year 👍

 

[Cornell08]

Like most people throwing out Occupy tags, you aren't too knowledgeable yet chose to make inflammatory comments.

I stated explicitly I am no expert on student loans as I am still going through the application process to get into medical school so you should stop being so peevish.

The brief point I was making before you started steering the thread off topic was that there is a great deal of compound interest and it is to the detriment of medical students who want to go into primary care. They have to pay that off and the costs ultimately get passed along to the customer indirectly along with supplies, malpractice insurance, rent, utilities, nurses, secretaries, etc. If there was a reasonable way to defray the debt of primary care doctors then ultimately this would benefit the patient and the taxpayer. With available and competent primary care doctors the system would really on prevention and not reaction. Many (rural) communities today simply do not have the primary care physicians they need. Even many suburban and urban areas have extensive waitlists or doctors who cannot fit into their practice and it's a shame.

I don't believe forcing physicians to become primary care physicians is the answer as has been suggested-- it is a good recipe for job dissatisfaction. Look, health care makes up 2.6 trillion dollars of spending per year (http://opinionator.blogs.nytimes.com/2011/10/27/spending-more-doesnt-make-us-healthier/). My suggestion would cost 1.5 billion and would move the 70/30 (or 85/15 as I have seen listed) specialty/primary care balance by proving 150k in loan relief to those who go into primary care residencies (up to 10,000 per year out of 20,000 US DO/MD grads). Obviously having at least half of my loans paid off is appealing to me as I've suggested it and am interested in becoming a pediatrician....for those SDNers on the fence, would having 150k knocked off your loans help sway you to practice in a primary care field?

 

[Drrrrrr. Celty]

Those seats would be for applicants who are willing to make that commitment. Non-PCP seats would be for those who don't want to be restricted (i.e. you).


Dental school isn't easy to get into, and ironically most dentists become GPs anyways. Other healthcare fields are having issues. And, the current economic climate is making jobs hard to come by. Unemployment rate for recent college grads are pretty staggering. Finally, there's no force because you can apply to only the non-PCP spots.

Anyways, that's it for me. Adding new schools/expanding class sizes will end up achieving the same results. GL on your application next year 👍

What did you score on the verbal section of the Mcat?......

 

[poopyhead]

What did you score on the verbal section of the Mcat?......

I guess we just have to disagree then.

I took a dump on the verbal 😴 It was by far my lowest section. I got a 9. Although, I wasn't born in the US....does that count as an excuse?

 

[Drrrrrr. Celty]

Sigh... I'm just trying to help you put this into a perspective you'll understand so that you'll see why this is a bad policy.

Ok, you sigh up for the program to be a PCP. Now you're happy, but then you do a surgery residency ( Prior to this you hated the field and believed it was poop and not for you) and you discover that this is something you were born to do, something that makes you happy like no other. You then know it can't be done and become a PCP and constantly are sad that you can't be a surgeon and find your IM residency uninteresting. You then have to live with that life choice, forever.
See what I mean? You're going to change your mind in medical school many many many times. And until you reach your rotations it's unlikely you can truly know what you want to do.

Well that it, I've beat a dead horse.

 

[Bacchus]

Is it easy to get a Gen surgeon/anesthesiologists job in a rural area? I'm asking because it kinda looks like you're going for Gas.

Gas piqued my interest, but probably medicine or FM. This was actually an anesthesia rotation I was talking about and it seems if there is a demand they'll take you. Where I was, the anesthesiologist was aging and it was just him and 2 CRNAs so I think they would love another anesthesiologist on board.

 

[Spatula]

Forcing people into primary care early is not the way to go. Primary care is tough, the pay is mediocre and the hours are very long. Making people do what they normally wouldn't want to do is going to create a generation of resentful crappy doctors. Burnout rates would be even higher than they are now.

The way is to make primary care a more attractive option so more people CHOOSE to go into primary care. That's pretty much going to have to mean a redistribution of physician pie away from specialties. I'd think call hours would become more reasonable as more and more PCP are in your practice as well.

 

[Prncssbuttercup]

So the NHSC has several different options for loan repayment of anyone who goes into a primary care field, OB/GYN, IM, FM, or Psych, AND is willing to work in a rural or high-needs urban area. There are scholarships, which are very inflexible and not for everyone, and there is loan repayment, which ANYONE can qualify for if you work in a specified clinic or area. If you do loan repayment, you get 100% of your loans paid off if you work for 6 years. You can get up to 30k/yr (maybe more depending on the incentives offered by the state you want to work in) for each year of service, with a minimum of 3 years. The scholarship program requires 2 years of work (FT, 4yrs PT) PER year of money received. If you received scholarship money all four years of med school, you owe them 8 years in an area of THEIR choosing. The loan repayment money is hard to get at best, but not impossible, and these are about the only federal options currently on the table. Who knows if they'll be around in 6-8+ years when any of us finish school and residency.

I want to do a loan repayment option, I would love to work with a rural or urban high-needs group and get ~45k/yr in loan payoffs tax free (figure 270k/6yrs). That's quite a salary bump. I'm currently torn on working in the middle of nowhere or working in an urban high-needs area. Both have pros and cons. Either way, there are some incentives, but they are very few. The government can't pull its head out of its butt to even fix our current budget problem, I highly doubt they'll be able to pull it out to fix this issue. Not to mention, the GOP doesn't care about primary care, that is a problem poor and rural people have, not their constituents. Most of their coffers probably have their own staff physician. It is up to those of us who care about the problem to do something about it. I know I am not going into this to be rich (more comfy than now, but not 'rich'), I'm going into it to help people. I can help more people more effectively by being a primary care doc. Likely that will be IM because I think I'm pretty sure I don't want to do FM... we'll see... anyway... Don't expect the US Fed government to fix anything, they can't even cross a street without a 2hr debate...

 

[poopyhead]

Sorry I brought up the suggestion guys 🙁

I guess I'm just a bit peeved to see so many fellow applicants emphasize during their interviews/personal statements that they want to do PCP or rural/underserved areas or the almighty "I wanna help people," when it appears to be all lip service.

No one mentioned that (s)he had a non-PCP residency in mind.

No one mentioned...

It's because not enough people want to incur 200k+ debt from medical school and undergraduate education to pursue a low paying specialty with call and long hours.

Primary care is tough, the pay is mediocre and the hours are very long. Making people do what they normally wouldn't want to do is going to create a generation of resentful crappy doctors. Burnout rates would be even higher than they are now.

I guess I'm just naive to believe there are actually applicants who will look beyond the crappy PCP/rural/underserved tuition:salary ratio and the "it's not worth it after XXXX amount of schooling." I guess there are no applicants who may end up liking another specialty more, but still wouldn't mind PCP/rural/undeserved because you know...the "I wanna help people" stuff. o well.....

 

[Cornell08]

I don't think your guilt trip is particularly fair to the people posting in this thread-- the topic is the primary care shortage and I do think many of the people who extol the virtues of primary care in their interviews are genuine about it but many medical students get scared away because the incentives are weighed against primary care in the current system. Personally, I think most people who want to go into primary care realize it's tough and would be fine making 100-150k per year which is good money. But when you leave your residency and have 300-400k in debt and are accruing potentially 30k in interest alone, and your 100-150k gets taxed pretty hard as it is, then close to a third of your post tax earnings are probably going to be going to pay off the interest alone and none of the principal. Now if you can go into a radiology residency and make 250k a year or more a year with a generally better quality of living then why not do that? Programs like the NHSC program and my made up program do provide more incentive. It's silly to have to worry about repaying your med school loans when you're 50. There is no vow of poverty in the Hippocratic oath. Something has got to give and that's what I take away from this thread. The growing shortage of PCP in the next 10 years is truly alarming but unfortunately makes a lot of sense even to those who are very interested in primary care.

 

[Spatula]

Just because I brought up problems in primary care doesn't mean I'm not interested in it. As a naive MS-0 I'd say there is an 80% chance I'd like to be a general internist but that doesn't mean I wouldn't like to leave the possibility open that I might find something in particular fascinating. Not even worrying about pay/lifestyle, what if I just really enjoy working with diagnostic imaging and love the type of thinking and problem solving that goes along with radiology?

I have a lot of experience with family and their colleagues in primary care and it is tough. Many of them truly enjoy their jobs and have no regrets about not specializing. They don't like their call schedules and the administrative/legal crap they put up with but they love the type of interactions they have with their patients. They are who have inspired me. It's not that they like primary care because it's the most altruistic specialty, it's because they simply enjoy the type of work.

However I've also met a couple PCPs who are absolutely miserable and absolutely hate their jobs. They're not idiots, they don't kill patients with malpractice but they do not go the extra mile for their patients. They aren't their patient's advocates. They could care less if you follow your treatment plan. Trust me, you do not want a generation of PCPs who were coerced into their jobs with the current conditions. Would these bitter doctors be more effective if their conditions were better? Dunno, probably?

Even if I decide for sure that my heart is into primary care I don't think I'd appreciate it if someone came along and told me I was forced to do it.

 

[Goro]

Excellent question, but for starters, medical schools can't just up their class sizes at will. There is a very thorough vetting process by COCA (our accrediting agency).

Theoretically, it's possible on a contractural basis...I give you admission, you get a break on tuition, and you go serve here in these X counties when you graduate. I think that the state of Kansas had just such a program.

If there is a nationwide shortage of PCPs, couldn't medical schools just create additional seats in entering classes, in which the persons who fill those additional seats must enter a primary care specialty?

 

[poopyhead]

I do think many of the people who extol the virtues of primary care in their interviews are genuine about it but many medical students get scared away because the incentives are weighed against primary care in the current system. Personally, I think most people who want to go into primary care realize it's tough and would be fine making 100-150k per year which is good money. But when you leave your residency and have 300-400k in debt and are accruing potentially 30k in interest alone, and your 100-150k gets taxed pretty hard as it is, then close to a third of your post tax earnings are probably going to be going to pay off the interest alone and none of the principal. Now if you can go into a radiology residency and make 250k a year or more a year with a generally better quality of living then why not do that?

See, that's the issue. This portion gets conveniently left off. Everyone who interviews/writes "yea, PC is great and all...." leaves off "but....it's not worth it, so I'll rather gun for rad" or even what Spatula just mentioned "yea, I'm 80% sure of PC, but that remaining 20% is reserved for something else." Having certain PC-only or rural/underserved-only seats are for adcoms to get applicants who have weighed all the negatives, but are still willing to make the sacrifice.

 

[Cornell08]

I respect your point of view, poopyhead, and when people ask what I want to do with my future degree I say become a pediatrician but I usually add a clause that who knows what will spark my interest in med school.

I always roll my eyes a little at high school seniors, especially after I was in college, when they'd profess so adamantly that they wanted to be a biology major or a history major or a communications major because we all know that a majority of college freshman end up majoring in something else. I viewed those people who were so utterly sure and who ended up finding some other interest to be very dishonest with themselves. From what I have been told by people in medical school and doctors that there is the same sort of dynamic in choosing ones career path.

Now the retort I'm expecting is that we really need primary care doctors-- which is true---but I am also interested in psychiatry (worked in a psychiatry lab for 2 years, was a psych major, etc.) and what if I become a child psychiatrist? In many rural areas, child psychiatrists are in even more need than GPs. Last I checked there were only 2 child psychiatrists in Wyoming. 2! So what if I sign up for a primary care only spot and decide that I love psychiatry and I love children and I want to become a child psychiatrist? They're needed but you know what, sorry, too bad, you're locked in and if you want to get out you have to pay some horrible fine, etc.

I commend you for your evident commitment to primary care and I wish you the best.

 

[Drrrrrr. Celty]

I respect your point of view, poopyhead, and when people ask what I want to do with my future degree I say become a pediatrician but I usually add a clause that who knows what will spark my interest in med school.

I've said this 4 times.

I always roll my eyes a little at high school seniors, especially after I was in college, when they'd profess so adamantly that they wanted to be a biology major or a history major or a communications major because we all know that a majority of college freshman end up majoring in something else. I viewed those people who were so utterly sure and who ended up finding some other interest to be very dishonest with themselves. From what I have been told by people in medical school and doctors that there is the same sort of dynamic in choosing ones career path.


Now the retort I'm expecting is that we really need primary care doctors-- which is true---but I am also interested in psychiatry (worked in a psychiatry lab for 2 years, was a psych major, etc.) and what if I become a child psychiatrist? In many rural areas, child psychiatrists are in even more need than GPs. Last I checked there were only 2 child psychiatrists in Wyoming. 2! So what if I sign up for a primary care only spot and decide that I love psychiatry and I love children and I want to become a child psychiatrist? They're needed but you know what, sorry, too bad, you're locked in and if you want to get out you have to pay some horrible fine, etc.
Shame, you shouldn't have signed up for the PC seats! You should obviously have known by your senior year what you wanted to do! I mean like really!
I commend you for your evident commitment to primary care and I wish you the best.

Yah...