It will be interesting to see how the workforce predictions for physicians will be. Nearly half, or perhaps more than half, of medical school entrants are women. Womens enter primary care predominantly more than males. Female physicians are more likely than men to want to work part time. Where will that leave primary care physician supply in 10 years?

We will see what it is like when access shrinks. The long training pipeline and relative lack of flexibility with which physicians can change from one specialty to another slows down the responses of a supply and demand market, but evidently not forever.

How would a strapped practitioner manage to hang on? Unless I wasn't busy, I might take a close look at who was paying what and start making decisions about which insurance plans I was really willing to accept anymore and which I could do without. Lousy managed care plans and public insurance like Medicaid wouldn't do well in that analysis, at least anywhere near me. Then I would look at private insurers and decide which of those I would put on a watch list. Plans that gave long delays to pay, regardless of schedules might get dropped if they didn't shape up.

No doubt some patients wouldn't be happy. That would be unfortunate. But it is now apparent that a system that many patients treat as a license to avoid responsibility for full payment for services just isn't working.

Most family practitioners knew when they entered their specialty that they weren't going to earn as much as surgeons. That is no surprise to anyone in medical practice. What they didn't bargain for, and shouldn't have to accept, is a practice environment
that denies them a fair living for someone with their skill and for their effort.

Refusing insurance doesn't mean charging unfair prices, the reverse in fact. And it doesn't mean that people can't make use of their medical insurance plans, in fact it would have them using their plans more directly than most ever have. It would put an end to the lie that a medical insurance plan is some sort of credit card company or ATM for paying bills that are never reported until an EOB comes in the mail. That might be the best benefit of all.

CH

With medical school debt increasing, malpractice coverage rates increasing, patients with more co-morbid illnesses increasing in number, appallingly low wages during residency, physician work hours increasing, work hours spent completing bureaucratic paper work increasing, decreasing reimbursments, and an increasing threat of lawsuits, I don't find it surprising that family medicine is becoming less of an attractive field. I do find it suprising that inspite of all these trends medical schools still attract the best and brightest minds throughout the country. Are current medical students naive or hopelessly optimistic about their future prospects? Either way, I wish these brave young souls well in their endeavers. After all, someones got to do it.