The New York Times led the paper today with its story on the severe nationwide shortage of primary care physicians. It said that the severe shortage threatened the success of health care reform proposed by the Obama administration, because there simply are not enough general internists to look after our population even without counting the 40 million or more uninsured who would gain greater access to health services with the envisioned insurance reform.
The story noted the difficulties in Massachusetts following our own health care reform, where we started with relatively more primary care physicians than are available nationally, yet still have newly insured patients going to expensive and slow emergency rooms because currently practicing primary care physicians are maxed out.
The economic cause of this shortage, namely the poor compensation for primary care services matched with the highest level of professional responsibility and greatest administrative burden, was discussed. The need for substantially greater pay was touched on (it rarely is publicly), but the true magnitude of the effort to revitalize primary care was not, in my judgment, really explored.
No Easy Fix
Because the decline of residents going into primary care has been going on for at least a decade, and because the older PCPs are burning out and phasing out more quickly, and because the insurance reimbursement for primary care services is in general less than one half that for specialty services and hence correcting that disparity will require an extraordinary effort, my personal estimate is that we have at least a decade and more likely 15 years to repopulate primary care with well-trained and enthusiastic practitioners.
I plan to write more extensively on this topic this spring. My earlier post in January (The Progressive Decline of Primary Care), from a letter I wrote to the Harvard Medical Alumni Bulletin a year earlier, summarized the problem. The details are perversely fascinating, but relevant to all of us.
