COMMENTARY

Desperately Seeking More Primary Care Docs

Alok S. Patel, MD

Disclosures

December 20, 2018

A looming public health threat in this country is the primary care physician shortage. It's getting worse; we need to act quickly. According to the Annals of Family Medicine,[1] we're going to need an additional 52,000 primary care doctors by the year 2025.

Primary care is the foundation of preventive healthcare, one of the most complex areas in all of medicine. And good primary care is a surefire way to keep healthcare costs down.

Doctors I talk to see two main ways to address this. First, more students need to go into primary care. And second, we need more doctors in general.

Getting more students to go into primary care is complicated. Some doctors feel that medical schools don't give primary care justice. They only offer a quick glimpse into the field.

One solution would be targeted curriculums, like the TRUST (Targeted Rural Underserved Track) program at the University of Washington School of Medicine. There's also the idea that more community-based residency programs would inspire and train more residents to work in primary care or in underserved communities.

Then there's the financial incentive. New York University famously stopped charging tuition for medical students, hoping that without the stress of debt, more students would pursue primary care.[2] The response to this has been mixed. But here's an idea: Why don't we just increase reimbursements for primary care docs? What a concept.

We also need more doctors in general. Every year, there are unmatched residents and an excess of students applying to medical school.[3] But we have a shortage of doctors. Why the disconnect? Well, in 1997, Congress capped the Medicare spending that would have expanded residency programs,[4,5] and the bipartisan Resident Physician Shortage Reduction Act of 2017,[5] which would have addressed this, hasn't been passed. We need more lobbying about this.

The bottom line is that major physician shortages will hit home in 10 years, and it takes at least 7 years to train a primary care doctor. Do the math. We have to act fast and we should probably pursue every option: dedicated education tracks, financial incentives, lobbying—the works. Because if we don't, public health will suffer.

Chime in. What are your thoughts? What do you think is the best way to fix the primary care doctor shortage?

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