Demand for family doctors grows as shortage deepens
By Paul F. P. Pogue
When Dr. Meghan Tramontozzi graduated Tufts University School of Medicine last May, she faced a difficult decision: Go into primary care, the lowest-paying area of medicine, or specialize in a more lucrative career. Her medical school debt - $250,000 - brought enormous financial pressure into the equation.
"Choosing primary care wasn't an easy thing because of the debt I'm going to deal with," says Tramontozzi, who now sees patients through a Tufts clinic. "But I fell in love with family medicine. I get to see kids, their parents and grandparents and know them in the context of their family rather than just an isolated visit in a specialist's office."
A key reason for the shortage of family doctors is pay. How their average annual salary compares to other specialties:
Primary care doctors
Source: Medical Economics
*Primary care includes general practitioners, pediatricians, family physicians and internists
Medical experts say fewer medical students are choosing Tramontozzi's path. The number going into primary care has halved in the last decade, as graduates flock to other specialties in search of better pay and hours, and it's having an effect on patient care.
Trevar Riley-Reid, a tutor in Linden, N.J., says her family is forced to use the emergency room or urgent care facilities for run-of-the-mill health problems due to the enormous backlog in area doctors' offices. "You're looking at really long wait times - around three months - and that's if they're even taking new patients," Riley-Reid says. "The whole situation stinks."
It's only going to get worse. According to the American Academy of Family Physicians, population growth and rising numbers of elderly are expected to create a serious shortfall by 2020 in at least five states - Nevada, Arizona, Florida, Texas and Idaho. But all states need to add more primary care doctors, adds the Academy, and the overall number of family physicians must grow by 39 percent in the next 12 years to keep up with the nation's needs.
Numerous studies show that patients in places with strong primary care systems experience earlier detection of cancer and other ailments, longer life spans and lower costs. Dr. Barbara Starfield, a professor at Johns Hopkins University who has studied primary care extensively, says unnecessary specialist or hospital visits that could have been handled by a primary care doctor cost an average of $2,560 per patient, per year.
Dr. Patricia Sereno, president of the Massachusetts Academy of Family Physicians, says she witnesses the value of primary care firsthand every day in her practice in Malden, Mass.
"I had a 30-year-old man come in for his first physical, and his blood pressure was sky-high," Sereno says. "That's a problem people don't know they have, because there are no symptoms. He might have gone 10 years with that hypertension that could have led to a stroke. But if we catch it earlier, we can treat it more effectively."
The Patient Centered Primary Care Collaborative, a coalition representing the country's national business leaders, policymakers and primary care physicians, plans to recognize primary care practices as patient-centered medical homes. Several pilot programs are underway.
According to Dr. Jim King, president of the AAFP and a family physician in Selmer, Tenn., many primary care doctors want their practices to serve as patient-centered medical homes - where they coordinate a team of health professionals in order to provide treatment of the whole patient rather than individual diseases or illnesses. Utilizing health information technology, including electronic health records, King says this approach helps prevent and manage chronic disease and features consumer conveniences, such as same-day scheduling.
In order to better balance primary and specialty salaries, it also encourages changes in pay that would recognize time-consuming work, such as administration or phone and e-mail consultations, which aren't reimbursed by most insurance carriers. "I don't get paid for about 40 percent of the work I do," King says.
But the major forces of the medical industry are starting to wake up, and King hopes it will help the shortage. "There really is a light at the end of the tunnel," he says. "This is beginning to take hold with government and insurance companies. We're looking at a whole new way of paying for primary care."