What is the easiest solution to the primary care shortage? My thoughts inside.

[mrh125]

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Well, I've been reading schools admission statements and nearly every school seems to have a devised a program to filter people into primary care quickly and easily to the point where some are really going out of their way to incentivize it. Some even offer 3 year plans for MDs and guaranteed primary care residency slots. Even with that I honestly wouldn't consider primary care unless things seriously change. There's very few incentives to get into it and pediatricians and the primary care doctors I talk to mostly give me very negative feedback regarding their position. I heard all the time how my pediatrician and my parents' primary care doctors really wish they could back to medical school + residency, choose a different specialty because with the long hours they work their salaries tend to be lower on average than other doctors (some of them said they're barely making it), and told me to never go into primary care because of that.

If primary care doctors were paid closer to other specialities I think that would be a way greater incentive. What's preventing that from happening realistically? The other alternative is to offer to relieve primary care doctor's debt accumulated in medical school and residency. Though this is very unfair to other specialities (either way honestly is).

Maybe primary care doctors could require more responsibility, be able to do more in patient procedures, and require higher step 1 scores. If you raise the technical requirements then that would justify a greater step 1 score (i'm getting the feeling primary care is basically the barren wasteland for people who do not perform well on step 1s and have very few options), more stringent residency requirements, and thereby a greater professional salary. If you rework the image of primary care physicians and what they can do, that very well be the solution.

Other than that there's the physician concierge services, which really help a lot of primary care doctors make ends meet.

What is the easiest solution to the primary care shortage? What are your thoughts on the matter?

 

[darkjedi]

The simple fact of the matter is that the reimbursement scheme needs to change.

You also have everything backwards. You can't just "increase" the "technical requirements", whatever that means, and expect that family care to all of a sudden be well paid.

 

[mrh125]

The simple fact of the matter is that the reimbursement scheme needs to change.

You also have everything backwards. You can't just "increase" the "technical requirements", whatever that means, and expect that family care to all of a sudden be well paid.

Increasing the level of technical skill and technical requirements to be a primary care doctor thereby allowing them to do more in-patient procedures would incentivize and justify them being paid more. This logic comes from looking at how most of the higher paid specialities require greater technical skill, often times responsibility, and pressure. You're definitely right about the reimbursement scheme though.

 

[AlbinoHawk DO]

Money

/thread

 

[mrh125]

Money

/thread

The whole money aspect is a huge balancing game though and that's part of the reason why I brought this up. Give primary care doctors too much money and more specialized doctors will have the same issues primary care doctors seem to have. Give them too little and the problem won't be resolved.

 

[Mad Jack]

Increasing the level of technical skill and technical requirements to be a primary care doctor thereby allowing them to do more in-patient procedures would incentivize and justify them being paid more. This logic comes from looking at how most of the higher paid specialities require greater technical skill, often times responsibility, and pressure. You're definitely right about the reimbursement scheme though.

You're looking at the problem all backwards. "Primary care doctors don't make enough money because we have a procedure-based reimbursement system. I've got it, let's have them do more procedures!"

Reimbursement models would need to change to outcome-based prevention models, wages would have to increase, AND some degree of loan forgiveness would need to be involved for primary care to be an attractive specialty.

 

[Mad Jack]

The whole money aspect is a huge balancing game though and that's part of the reason why I brought this up. Give primary care doctors too much money and more specialized doctors will have the same issues primary care doctors seem to have. Give them too little and the problem won't be resolved.

You're looking at the problem all wrong, like it's a fixed pie and paying one more means paying the other less. Divert some ridiculous pharmaceutical payments to physicians and have a streamlined insurance system that substantially reduces overhead and you could pay primary care docs more without impacting specialist salaries in the slightest.

 

[WillburCobb]

The other alternative is to offer to relieve primary care doctor's debt accumulated in medical school and residency. Though this is very unfair to other specialities (either way honestly).

There's a plethora of programs like this already - many of which tend to go unfilled. I could've attended med school with my tuition and cost of living covered, but there's just too many strings attached.

 

[Muffinho]

Is there a primary care shortage, or a primary care shortage in rural areas?

 

[woltej1]

It'd come down to all money for me. No matter what your end specialty is, everyone incurs the same cost for schooling. I don't believe they should be reimbursed more, or at least an appreciable amount, to put them on the same level as other specialties simply because they don't deal with as complex of problems as specialties do. If they see something serious they send them to someone who can deal with it. I think were the incentive needs to come in is with schooling and some kind of well established tuition reimbursement. I know there are multiple programs like this, but there are usually conditions like it must be in a certain area, etc. If there is to be a large push into family practice then there needs to be a large, centralized push to make incentives. If I were to be able to graduate from med school with little to no debt because I signed some sort of contract to do family practice I'd do it then making $150-200K a year vs $100k more in other specialties would be worth it as I could actually enjoy a life style sooner. Then you can always look into a different specialty once the contract ends.

 

[kevinus]

You're looking at the problem all backwards. "Primary care doctors don't make enough money because we have a procedure-based reimbursement system. I've got it, let's have them do more procedures!"

Reimbursement models would need to change to outcome-based prevention models, wages would have to increase, AND some degree of loan forgiveness would need to be involved for primary care to be an attractive specialty.

Agreed. I wish our government helped out medical students who pursue primary care out of altruism instead of supporting more competition in their job market. I'm not against NPs and PAs but feel bad for the students going into family medicine.

 

[masaraksh]

I thought the 2015 MCAT and the sociology requirements were going to solve this.

 

[WillburCobb]

Is there a primary care shortage, or a primary care shortage in rural areas?

It's primarily a maldistribution.

 

[Mad Jack]

I thought the 2015 MCAT and the sociology requirements were going to solve this.

🤣😆🤣
No, just no. The new requirements aren't meant to be predictive of primary care potential in any way whatsoever.

 

[repititionition]

1) Do you know what the RUC is? Please come back once you do.

2) If there were an "easiest solution", it would have been implemented already.

3) The PC "shortage" (note that nearly every speciality is considered to have a shortage, making the distinction somewhat useless and ultimately subjective) is driven by two things:

A) Money, as others have alluded to. The ROI on a medical education is simply lower for PCP's than for other specialties.

B) Primary Care is becoming social and administrative rather than clinical work. The market forces grinding down medicine as as profession have hit PC hardest, and "smart" medical students have taken note.

 

[masaraksh]

🤣😆🤣
No, just no. The new requirements aren't meant to be predictive of primary care potential in any way whatsoever.

What if the NRMP, The US Government, and Porsche of America create an initiative for everyone that if you match to primary care it comes with a Porsche (that seems to be important for many based on the other threads). Like, the keys come in the same envelope as the match letter in March.

 

[mrh125]

I thought the 2015 MCAT and the sociology requirements were going to solve this.

If the 2015 mcat solved anything except the problem of some premeds actually having a less stressful life and not dedicating 8 hrs of time to this ridiculous abomination of an exam i'd be shocked.

 

[mrh125]

You're looking at the problem all wrong, like it's a fixed pie and paying one more means paying the other less. Divert some ridiculous pharmaceutical payments to physicians and have a streamlined insurance system that substantially reduces overhead and you could pay primary care docs more without impacting specialist salaries in the slightest.

that makes sense but pharmaceutical programs and insurance premiums are pretty successful at making a killing at the expense of pretty much everyone else and i'm not sure how that's going to change.

 

[Chipster.]

Do you guys remember how we made a thread just for streampaw to ask her questions so she wouldn't make a new thread every hour?

Yeah. I think it's gettin' to be about that time...

 

[mrh125]

Do you guys remember how we made a thread just for streampaw to ask her questions so she wouldn't make a new thread every hour?

Yeah. I think it's gettin' to be about that time...

If you're just looking for something to complain about, meh I ask questions whenever I'm curious or want others feedback/to know about something. If you're actually gonna answer my questions in one thread, sure why not? 🙂 I wouldn't complain. I help other people out too, so it's not like i'm solely asking questions here. There's a lot to learn about.

 

[terp720]

If the 2015 mcat solved anything except the problem of some premeds actually having a less stressful life and not dedicating 8 hrs of time to this ridiculous abomination of an exam i'd be shocked.

it's a problem that some pre-meds don't have a stressful life? not sure if you actually mean that or if you're just using it there sarcastically....

 

[mrh125]

it's a problem that some pre-meds don't have a stressful life? not sure if you actually mean that or if you're just using it there sarcastically....

It's sarcastic and a jab at the 2015 mcat. I really don't like how they're changing it and how much (arguably unnecessary) stress it will put on students in my perspective, but I do recognize the benefits of making it more similar to the USMLE exams in terms of their duration. There should be more to premeds lives' than having to put everything into their future in medicine and as an undergraduate who was consumed by the process for a long period of time, it's a huge issue imo. People really need time to enjoy their lives and enjoy the perks of being a college student/young adult and taking away that part of their life bothers me.

 

[DrEnderW]

Maybe primary care doctors could require more responsibility, be able to do more in patient procedures, and require higher step 1 scores. If you raise the technical requirements then that would justify a greater step 1 score (i'm getting the feeling primary care is basically the barren wasteland for people who do not perform well on step 1s and have very few options), more stringent residency requirements, and thereby a greater professional salary. If you rework the image of primary care physicians and what they can do, that very well be the solution.

It's not your fault, but I think you have a colossal misconception on how difficult it is to get a "higher Step 1 score." Furthermore, a higher score has nothing to do with the capacity to perform procedures...

 

[Lucca]

Fix primary care? Change the patient population

/cynicism.

 

[mrh125]

It's not your fault, but I think you have a colossal misconception on how difficult it is to get a "higher Step 1 score." Furthermore, a higher score has nothing to do with the capacity to perform procedures...

In what direction? easier or harder? I look at the step 1 as imposing, difficult, and competitive standardized test more selective than the mcat. I realize that it has nothing to do with capacity to perform procedures and I've even argued that before, but there is a correlation between higher step 1 scores and speciality options available to one.

 

[Lucca]

In what direction? easier or harder? I look at the step 1 as imposing, difficult, and competitive standardized test more selective than the mcat. I realize that it has nothing to do with capacity to perform procedures and I've even argued that before, but there is a correlation between higher step 1 scores and speciality options available to one.

Ask yourself: Why do ROAD specialties have high Step 1 cutoffs?

Those specialties get lots of applicants, more applicants than they could possibly match. The cutoff score rises since with a bigger applicant pool it will take higher and higher scores to be accepted. Step 1 is a slave to competition, supply/demand just like the MCAT is.

Why is HMS's average MCAT score so high? Is it because they think a higher MCAT translates into anything clinically meaningful? No. It's because there's tons of people applying to that school and they will pick the best simply because they can.

You can't just say Voila, PCP now has a Step 1 cutoff of 240!

 

[mrh125]

Ask yourself: Why do ROAD specialties have high Step 1 cutoffs?

Those specialties get lots of applicants, more applicants than they could possibly match. The cutoff score rises since with a bigger applicant pool it will take higher and higher scores to be accepted. Step 1 is a slave to competition, supply/demand just like the MCAT is.

Why is HMS's average MCAT score so high? Is it because they think a higher MCAT translates into anything clinically meaningful? No. It's because there's tons of people applying to that school and they will pick the best simply because they can.

You can't just say Voila, PCP now has a Step 1 cutoff of 240!

ROAD are more competitive due to higher incentives and more interest in them. Although, I know this, but I still think there is a higher level of technical skill required to a degree in some of those more competitive higher-end specialities. If you compare the work and technical knowledge a dermatologist or neurosurgeon has to know compared to a pediatrician or primary care doctor, there is is definitely a difference. I'm just thinking of an easy way to screen for more technical aptitude if primary care is reworked like I suggested in an earlier post.

What you're saying makes a lot of sense and I appreciate the explanation.

 

[WillburCobb]

Ask yourself: Why do ROAD specialties have high Step 1 cutoffs?

Those specialties get lots of applicants, more applicants than they could possibly match. The cutoff score rises since with a bigger applicant pool it will take higher and higher scores to be accepted. Step 1 is a slave to competition, supply/demand just like the MCAT is.

Why is HMS's average MCAT score so high? Is it because they think a higher MCAT translates into anything clinically meaningful? No. It's because there's tons of people applying to that school and they will pick the best simply because they can.

You can't just say Voila, PCP now has a Step 1 cutoff of 240!

Purdy much. @mrh125 , variables - ur leaving them out.

 

[Lucca]

ROAD are more competitive due to higher incentives and more interest in them. Although, I know this, but I still think there is a higher level of technical skill required to a degree in some of those more competitive higher-end specialities. If you compare the work and technical knowledge a dermatologist or neurosurgeon has to know compared to a pediatrician or primary care doctor, there is is definitely a difference. I'm just thinking of an easy way to screen for more technical aptitude if primary care is reworked like I suggested in an earlier post.

What you're saying makes a lot of sense and I appreciate the explanation.

How do you 'rework' primary care then to attune it to be more clinically/intellectually stimulating? Who, then, will be the primary care doctor?

 

[masaraksh]

ROAD are more competitive due to higher incentives and more interest in them. Although, I know this, but I still think there is a higher level of technical skill required to a degree in some of those more competitive higher-end specialities. If you compare the work and technical knowledge a dermatologist or neurosurgeon has to know compared to a pediatrician or primary care doctor...

😆pimple popper MD... lots of skill and technical knowledge?

 

[Lucca]

😆pimple popper MD... lots of skill and technical knowledge?

You know nothing about anything.

 

[NontradCA]

You're looking at the problem all backwards. "Primary care doctors don't make enough money because we have a procedure-based reimbursement system. I've got it, let's have them do more procedures!"

Reimbursement models would need to change to outcome-based prevention models, wages would have to increase, AND some degree of loan forgiveness would need to be involved for primary care to be an attractive specialty.

There's NHSC. They will pay you to go to med school, and from what I've seen it isn't too competitive. I don't think money is the biggest issue. A lot of it has to do with a romanticized notion of medicine and people wanting to actually do procedures, not only because they pay well.

 

[Psai]

"Maybe primary care doctors could require more responsibility, be able to do more in patient procedures, and require higher step 1 scores. If you raise the technical requirements then that would justify a greater step 1 score"

lol you're looking at it all wrong. Having a high step 1 score doesn't mean that you'll be a better doctor or that what you do takes more brains. It just means that a lot of people want to do that specialty so program directors can set an arbitrary limit for a minimum score on a national standardized exam. And premeds should not be "comparing" between different fields of medicine. You have no frame of reference.

 

[mrh125]

How do you 'rework' primary care then to attune it to be more clinically/intellectually stimulating? Who, then, will be the primary care doctor?

Well, one thing that influenced my comments was reading about radiologists and working with one. Radiologists are a Doctor's doctor and are required to have knowledge of all sorts of different medical specialities (there's the technical knowledge I was talking about) and can do some surgical procedures and all sorts of different things and are viewed as this (also this is reflected in their pay). Primary care doctors are the doctors that people see before being referred to other specialities, so I'm thinking in residency programs primary care doctors could be trained in more technical skills and knowledge that allows them to do a lot bit of what each other speciality does more. With this knowledge, greater sense responsibility, and ability to do more this not only eases the transition from a primary care doctor to a speciality, but may give primary doctors more of a technical role and thereby incentivize higher pay.

It's like the whole generalist vs. specialist ecology deficiencies. A generalist (primary care doctor) should be able to do a bit of everything.

 

[mrh125]

"Maybe primary care doctors could require more responsibility, be able to do more in patient procedures, and require higher step 1 scores. If you raise the technical requirements then that would justify a greater step 1 score"

lol you're looking at it all wrong. Having a high step 1 score doesn't mean that you'll be a better doctor or that what you do takes more brains. It just means that a lot of people want to do that specialty so program directors can set an arbitrary limit for a minimum score on a national standardized exam.

it's also an easy metric for residency programs to utilize to be more selective. if not step 1, then perhaps something else that already exists, which plays a role w/ what I mentioned that assesses technical prowess. It could really be anything.

 

[alpharez]

Free medschool if you go into primary care

 

[mrh125]

Free medschool if you go into primary care

I like that idea, but at the same time that would be a slap in the face to those MDs in other specialities who work just as hard in medical school and graduate with just as much debt.

 

[WillburCobb]

I like that idea, but at the same time that would be a slap in the face to those MDs in other specialities who work just as hard in medical school and graduate with just as much debt.

But it exists. Unfortunately there's a reason why people turn down these options.

 

[ninjaman22]

Is there a primary care shortage, or a primary care shortage in rural areas?

I think they are just too concentrated in certain areas i.e. parts of big cities, California, etc. Then there aren't that many PCPs in certain areas of a big city and then obviously rural areas.

 

[masaraksh]

You know nothing about anything.

ok, well a specialist, subspecialist, etc is someone who knows more and more about less and less.. until eventually he knows anything and everything about nothing.

 

[WillburCobb]

I think they are just too concentrated in certain areas i.e. parts of big cities

There's a reason why psyc starts at 250K where I live and you can use student loan debt as bargaining leverage.

 

[Cyberdyne 101]

What if the NRMP, The US Government, and Porsche of America create an initiative for everyone that if you match to primary care it comes with a Porsche (that seems to be important for many based on the other threads). Like, the keys come in the same envelope as the match letter in March.

I'd prefer a partnership with Land Rover.

 

[mrh125]

LOL, how about a partnership with ferrari? Give all primary care doctors a ferrari as their "business vehicle" for "strictly primary care business purposes" 😛. Even w/ less of a salary they'd still have ferraris.

 

[Cyberdyne 101]

LOL, how about a partnership with ferrari? Give all primary care doctors a ferrari as their "business vehicle" for "strictly primary care business purposes" 😛. Even w/ less of a salary they'd still have ferraris.
View attachment 180762

I see MD plates on Range Rovers all the time. A few times on a Mercedes CL600. I have yet to see a Ferrari with MD plates-lol.

 

[mrh125]

I see MD plates on Range Rovers all the time. A few times on a Mercedes CL600. I have yet to see a Ferrari with MD plates-lol.

haha. Come to Marin, CA then! you'll see MD plates on porsches, mercedes, range rovers, higher end bmws, and a few ferraris. 🙂 Also, if you're ever plan on becoming a plastic surgeon, work on setting up a practice there and you'd be swimming in the cash.

 

[ciestar]

If the 2015 mcat solved anything except the problem of some premeds actually having a less stressful life and not dedicating 8 hrs of time to this ridiculous abomination of an exam i'd be shocked.

You sound so bitter. Just let the mcat go. It's over.

 

[mrh125]

You sound so bitter. Just let the mcat go. It's over.

I was bitter about the 2015 mcat changes before I even took my mcat and got my score. It's more about the extremes and extraordinary amount of pressure it puts on students that is so unnecessary that bothers me. people need to enjoy their damn lives.

 

[ciestar]

I was bitter about the 2015 mcat changes before I even took my mcat and got my score. It's more about the extremes and extraordinary amount of pressure it puts on students that is so unnecessary that bothers me. people need to enjoy their damn lives.

There's nothing you can do about. Just let it go! Yes, it sucks, but if you really want to be a doctor you just deal with it and move on. Life is about making sacrifices, unfortunately. You have plenty of time to enjoy your damn life.

 

[WillburCobb]

I was bitter about the 2015 mcat changes before I even took my mcat and got my score. It's more about the extremes and extraordinary amount of pressure it puts on students that is so unnecessary that bothers me. people need to enjoy their damn lives.

They could bring back subject matter like historical architecture and topics on classics...

 

[Mad Jack]

I like that idea, but at the same time that would be a slap in the face to those MDs in other specialities who work just as hard in medical school and graduate with just as much debt.

They work just as hard in medical school, but their payout is much greater over their lifetime, even with the primary care physician's debt absolved. Some specialists make enough more than a primary care physician to pay off the average medical student's loan balance in a single year, so they aren't exactly being boned by going into a specialty vs primary care.