THURSDAY, Jan. 10 (HealthDay News) -- Amid signs of a growing
shortage of primary care physicians in the United States, a new
study shows that the majority of newly minted doctors continues to
gravitate toward training positions in high-income specialties in
This is occurring despite a government initiative designed to
lure more graduating medical students to the field of primary care
over the past eight years, the research shows. Primary care
includes family medicine, general internal medicine, general
pediatrics, preventive medicine, geriatric medicine and osteopathic
Dr. Candice Chen, lead study author and an assistant research
professor in the department of health policy at George Washington
University in Washington, D.C., said the nation's efforts to boost
the supply of primary care physicians and encourage doctors to
practice in rural areas have failed.
"The system still incentivizes keeping medical residents in inpatient settings and is designed to help hospitals recruit top specialists," Chen said.
In 2005, the Medicare Prescription Drug, Improvement and
Modernization Act was implemented with the goal of redistributing
about 3,000 residency positions in the nation's hospitals to
primary care positions and rural areas.
The study, which was published in the January issue of journal
Health Affairs, found, however, that in the wake of that
effort, care positions increased only slightly and the relative
growth of specialist training doubled.
The goal of enticing more new physicians to rural areas also
fell short. Of more than 300 hospitals that received additional
residency positions, only 12 appointments were in rural areas.
The researchers used Medicare/Medicaid data supplied by
hospitals from 1998 to 2008. They also reviewed data from teaching
hospitals, including the number of residents and primary care,
obstetrics and gynecology physicians, as well as the number of all
other physicians trained.
The U.S. government provides hospitals almost $13 billion
annually to help support medical residencies -- training that
follows graduation from medical school -- according to study
background information. Other funding sources include Medicaid,
which contributes almost $4 billion a year, and the U.S. Department
of Veterans Affairs, which contributes $800 million annually, as of
Together, the cost of funding graduate medical education
represents the largest public investment in health care workforce
development, the researchers said.
An earlier study, published in the December 2012 issue of the
Journal of the American Medical Association, showed fewer
residents are choosing primary care in the United States. Of
third-year residents, only 21.5 percent were planning on becoming
internists. Experts estimate that the nation will be short 50,000
primary care physicians in the next decade.
Chen said hospitals are likely to recruit specialty residents
because their presence benefits their facilities. "Having residents
in the hospital frees up the attending doctors to do more
procedures, which increases revenue for physicians and for the
hospital," she said.
What is driving the interest in medical specialties?
Dr. Perry Pugno, vice president for education at the American
Academy of Family Physicians, said he thinks the trend is based on
perceived quality of life. "Student interest in lifestyle has
pushed the pendulum away from primary care," he said. "You can make
more money and not work as hard. The income is somewhat a proxy for
Pugno said he thinks the primary care situation is even worse
than the numbers suggest. Many of the residents in primary care and
internal medicine will go on to pursue specialties, such as
cardiology or general surgery, he explained.
"Only 5 percent of those who go into internal medicine will actually stay in primary care," he said.
Pugno said the situation calls for a national workforce
commission to assess workforce needs, especially in shortage areas
such as primary care, general surgery and pediatric psychiatry. He
added that graduate medical education should be funded by a more
straightforward payment system than Medicare.
Chen, who practices in primary care once a week in an
underserved area of Washington, thinks part of the answer is to
ensure that primary care physicians are paid commensurate with the
other specialties. "It's not just about paying primary physicians
more; it's also about bringing down the pay of other physicians,"
It's also important for medical students and residents to
understand the importance and personal rewards of a career in
primary care, Chen said. "It's one of the hardest areas of
practice, but physicians often are told they're too smart to go
into family medicine."
For information about how to choose a primary care provider,
U.S. National Library of Medicine.
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