Are Primary Care Physicians a Thing of the Past?

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An interesting study conducted by the Mayo Clinic, cited at WebMD, suggests that the US may be facing a shortage of primary care physicians in the near future.

According to the Bureau of Labor Statistics, there were approximately 46,740 primary-care physicians employed in 2011. The American College of Physicians indicates the demand for primary care physicians will skyrocket as the population ages, health care needs increase due to increasing number of people becoming insured under the affordable care act, and increasing demand for acute, chronic, and long-term care. Even if the current number of internists remains constant, the ACP indicates, there would not be enough physicians in the future to meet the increased demand.

Medical Students Bowing Out

But the numbers of medical students choosing to become internists is not projected to rise, or even to remain constant. In fact, fewer and fewer physicians are choosing a career in general internal medicine. The first inkling of a shortage was suggested by a 1992 study that reported only about half of the students graduating from a general internal medicine program maintained a practice in general internal medicine. The ACP also cited a subsequent 2010 report that predicted the nation would be short by 45,750 internists by 2020.

A new study conducted by the Mayo clinic presents a comprehensive, if dark picture. Among 17,000 third-year medical students surveyed at the time of their exams, 21.5 percent stated they planned to pursue general internal medicine. Even among those students already enrolled in a general internist program between 2009 to 2011, only 40 percent said they planned to stick with internal medicine. Adding insult to injury, only about 20 percent of those enrolled in a traditional “categorical” program, planned on pursuing internal medicine.

Where Are They Going?

Colin West, MD, PhD, the Mayo study’s chief researcher, speculated on a number of causes for the shortage. West thinks that doctors today are seeking a better work-life balance than what is generally afforded to internists, who must work when their patients are sick, rather than sticking with convenient office hours. Many of the specialty medical practices offer part-time hours, flexible schedules and more control over office-visits hours than does a general internist practice.

Another potential cause is the almighty dollar. A simple economic fact is that doctors pursuing a specialty earn about twice as much as primary-care physicians. The 2011 BLS survey reported a mean annual salary of $189,210 for internists compared to cardiologists, who made $321,080.

One of the hardest to empirically measure but still important factors luring physicians away from a career in internal medicine is cachet. Martha S. Grayson, MD, senior associate dean at the Albert Einstein College of Medicine, found in her research that medical students are being enticed by the glamor of specialty medicine. It appears specialists such as neurosurgeons, radiologists and even toxicologists are more highly valued by society than are internists.