In recent years, there has been a decline in the number of medical students who want to pursue family medicine, though many say it is the frontline for wellness and preventive-care programs that can help reduce healthcare costs. According to the American Academy of Family Physicians (AAFP), the number of U.S. medical students going into primary care, which includes family physicians, general internists and general pediatricians, has dropped 51.8% since 1997. Medical specialists have cited the decline to such factors as longer days, lower wages, less prestige and less administrative headaches. Some experts believe the biggest problem is the payment model because the more procedures a doctor performs, the more money he or she makes. This encourages medical students to pursue a procedure-based specialty as opposed to a primary-care track.
Because it takes about ten to eleven years to educate doctors, health-care experts are worried that the decline will cause a shortage of 40,000 family physicians in 2020 when the demand is expected to spike. Eleven of the top conventional medical schools in the U.S., including Johns Hopkins and Harvard, do not even have a separate family-medicine department. Finding a doctor will become increasingly difficult; there will be longer waits in the waiting rooms and more people will turn to the emergency rooms to get help because the waves of patients will be enormous. When patients visit the doctor’s office, they may also see a nurse practitioner or physician’s assistant instead of the doctor due to the increasing demand. This practice of involving nurse practitioners and physician’s assistants in care is already in place to alleviate physicians from time-consuming tasks in order to focus on the continuity of quality care.
While the U.S. healthcare system has about 100,000 family physicians, it will need 139,531 in ten years; the current environment is only attracting half the number needed to meet the demand. At the heart of the rising demand for primary-care physicians is not only the current group of underserved patients, but the baby boomer generation also, born from 1946 to 1964. This generation will be turning sixty-five in 2011 and will need increasing medical care. If Congress passes healthcare legislation that extends coverage to a significant part of the forty-seven million that do not have insurance, the number of people requiring care will continue to escalate.
In March 2009, U.S. medical school graduates only filled forty-two percent (1,083) of the 2,555 resident positions for family medicine. More than two hundred positions were left unfilled nationwide. More than half of the other spots were filled by non-U.S. students educated internationally, U.S. citizens educated internationally and graduates of colleges of osteopathic medical schools, though graduates of international medical schools and osteopathic medical schools seem to be losing interest in primary care also. This presents the problem of some foreign students with poor English skills not being able to communicate well with their patients.
Members of Congress have taken notice of the potential “crisis” associated with the lack of primary care physicians and have begun looking into bills that could help doctors who choose primary care with loan forgiveness or other debt relief and payment increases for their services.