Low Pay, Difficult Conditions Make Family Practice Unpopular Choice

September 12, 2008 11:23 AM
by Emily Coakley
A survey of medical students suggests only a small percentage plan to enter family practice, a decline that has been charted for several years.

Fighting Insurance Companies

A report in the Journal of the American Medical Association says only two percent of medical students who are graduating plan to work in primary care, CBS News reports.

UPI quoted the report as saying: “Current students recognize the increasing demands on internists, particularly primary care physicians, to accomplish large numbers of preventive and therapeutic interventions during short visits with chronically ill patients while also managing increasing administrative expectations.”

One medical student told CBS he “didn’t want to fight the insurance companies.”

Practicing doctors don’t want to fight insurance companies, either. A group in Kansas City surveyed doctors to learn their opinions on local health insurance companies, including which ones had the “worst hassle factor.”

“I will guarantee you that nine out of 10 physicians in this city feel that the health insurance company is their adversary,” William Soper of Mid America Medical Affiliates, the group that commissioned the study, said to the Kansas City Business Journal. “And why should I spend the time, effort and frustration trying to save the insurance company money, when the insurance company is going to do everything they can to try to avoid paying me?”

Family physicians, on average, had the smallest salaries among doctors, and medical students have more and more debt. Paying medical malpractice insurance premiums also takes a chunk out of salaries.

Debate over whether malpractice awards should be capped has raged in many states. Texas, which enacted caps on medical malpractice awards, has seen an increase in doctors who want to practice there. Others say caps aren’t needed, and the threat of medical malpractice litigation helps keep doctors accountable.

The trend in fewer family physicians isn’t just an issue in the United States. The United Kingdom has also had a problem with finding primary care physicians. In 2002, British paper The Guardian wrote about the National Health Service recruiting doctors internationally.

The Guardian said, “Fewer medical students are now selecting general practice as a career and a majority of those who do are women, many of whom take time out to raise families or choose to work part-time. The result is a chronic shortage of GPs and a dearth of applicants for vacant posts.” The NHS wanted to recruit 2,000 primary care doctors by 2004.

A French doctor who came to practice in London said he hasn’t had a language issue. Yann Lefeuvre told The Guardian that he’s able to talk to immigrant patients from the Democratic Republic of Congo, formerly known as Zaire; Cameroon and Burundi in French.

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A blogger who identifies herself as Angoraknitter said at the military base where she lives in California, there are only two primary care doctors, and one is deploying soon. She thinks nurse practitioners may be a solution.

“At least to a certain point NP’s can run test [sic], conduct patient teaching, and prescribe a small list of standard medications. Maybe I'll go back to school when the kids are grown. NP's are cheaper to train and you don't have to pay them nearly as much as someone with M.D. at the end of his/her name.”

In 2006, Roger Rosenblatt, a professor of family medicine at the University of Washington’s School of Medicine, compared America’s health care system to a “house riddled with termites” and primary care doctors to a home’s “supporting beams.”

“They work to prevent illness before it occurs; manage people with complex chronic diseases; care for pregnant women and their babies; and attend to the mental-health and substance-abuse problems that produce so much illness and social disruption,” Rosenblatt wrote in The Seattle Times.

The solution, he says, is to encourage politicians to support “fair and adequate reimbursement rates” for federal health programs such as Medicaid, and support social policies that guarantee “access to basic health care” for all.

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