TUESDAY, May 24 (HealthDay News) -- The more primary care
doctors a community has, especially ones who are actually
practicing primary care, the healthier seniors in that community
are, a new Dartmouth study suggests.
Those communities see fewer preventable hospitalizations and a
slightly lower death rate among local elders, the researchers
"This reinforces something the American Academy of Family Physicians [AAFP] has stood on for a long time: that a well-trained physician can maintain outcomes," said AAFP president Dr. Roland Goertz, who noted that some 100 different studies have now come to the same or similar conclusions.
This study and others come in the context of a shrinking pool of
primary care doctors. A study last month found that the percentage
of medical students who want to go into primary-care medicine has
dropped sharply over the past two decades, from 57 percent in 1990
to 33 percent two decades later.
In 1990, 57 percent wanted to go into primary-care medicine vs.
33 percent in 2007, according to that earlier study. Those choosing
to practice general internal medicine in 2007 fell from 9 percent
to 2 percent. And in 2008, only 264 U.S. medical students chose
residency training in primary care internal medicine, compared to
575 in 1999.
Yet, having more primary care doctors is a cornerstone of most
strategies to improve health-care quality and lower costs in the
United States, the authors of the current study report. Their
finding appears in the May 25 issue of the
Journal of the American Medical Association.
These authors looked at physician claims for about 5 million
Medicare beneficiaries aged 65 and older culled from American
Medical Association files. The claims including specialty coding
for the physicians and the type of care provided, said study author
Chiang-Hua Chang, a research instructor with the Center for Health
Policy Research at the Dartmouth Institute for Health Policy and
Clinical Practice in Lebanon, N.H.
Seniors in areas with the highest number of primary care doctors
had fewer preventable hospitalizations and fewer deaths.
The differences were admittedly small. For example, the Medicare
enrollees living in areas with the most primary care physicians per
capita had a 6 percent lower rate of preventable
But the authors also found that it is not enough just to be
trained in primary care. Doctors have to be practicing primary care
as well, something that future studies need to take into account,
Many doctors trained in primary care seem to be practicing in
specialties such as emergency medicine or inpatient care only, she
"I think this raises several important questions," said Dr. Lawrence C. Kleinman, an associate professor of health evidence and policy at the Mount Sinai School of Medicine in New York City. "We need to be making sure that there are adequate primary care physicians and adequate distribution of those physicians."
"Right now, we tend to pay when doctors do things but we don't tend to value when doctors prevent things, which means manpower is shifting from primary care to specialty care," he added.
Is the shortage going to let up?
"Not in the way we currently organize and finance care," Kleinman said. "Medical students respond to their value and their market forces, and currently the amount of debt and reimbursement discrepancies are trumping people's values and other preferences."
The Health Resources and Services Administration has more on
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