Medpundit preaches to the choir on primary care:

The trick is to get family medicine (and pediatrics and general internal medicine) to be as attractive as specialty medicine and rural and poor urban areas to be as attractive as suburbia. One way would be to pay primary care doctors better. (Like that’s going to happen.) Or the field more “glamorous.” (Even less likely.) Specialty fields are attractive not just because they pay more, but also because a more narrow field of knowledge to master. That doesn’t make them easier to learn, but many people feel much more comfortable knowing a lot about a little than a little about a lot. Once technological advances made specialization necessary, it was inevitable that primary care would suffer.

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  • Anonymous

    Let’s see.

    Medical school enrollments are down. Entry into and completion of primary care residencies are down more than 50% over the past 10 years. In Ob/Gyn residencies, 25% of the slots are unfilled after all American M.D. graduates are matched.

    What we will see over the next 4 to 10 years is a dumbing down of American medicine.

  • gasman

    Historically medical schools have had more applicants than positions to offer; this is still true.

    Applicants have to be winnowed down on some basis and academic performance seems like a good criteria. Other criteria such as people skills would be great too, but identifying objective assessments is far more difficult.

    An airline pilot friend remarked that the best pilots aren’t the brightest guys in their class. Sure, you want guy’s who are reasonalbly sharp, who work hard and apply themselves. But the exceptional guy wants to think outside the box too much, rather than follow the best tried and true methods and adapt to the new methods as they roll out.

    Likewise in medicine, after we have the really bright guys and odd ducks who will be the research and innovation crowd, we should focus on intellectually average people who achieve sufficient academic skill though hard work and personalities that function well in team work.

    By opening up the applicant pool to a larger group we could pick from among them those who have the right personality to achieve good group function.

  • mchebert

    In the years before I applied to medical school, law school applications were way, way, up and med school apps were down. Some people called it the “LA Law” effect.

    Then, in the mid 90s med school apps skyrocketed, and law school apps sagged. Doctors started complaining about a doctor glut and AAMC was looking into reducing enrollment.

    Now, they are saying there will huge shortages in many areas, especially in primary care. Primary care is now a dying breed.

    I gave up listening to such prognosticators a long time ago. It seems to me free market forces will drive medical graduates to fields of shortage. In primary care, if the shortages are long term they will be filled by nurse practitioners and physician’s assistants.

    There is just too much money to be made in medicine for chronic shortages to persist.

    In the end, medicine will be “dumbed down” only if the patient (i.e., the paying customer) decides it is OK to be cared for by non-MDs. If the patient says no, then eventually demand will raise the salary of PCPs to a reasonable level.

    At any rate, I see no reason to worry about it. If the law of supply and demand can’t fix the problem of doctor shortages, I can assure you that no government policy will do it either.

  • dr john

    The law of supply and demand assumes a free market.
    Medicine is anything but a free market.

  • Anonymous

    I heartily agree with mchebert. Government interference will only make a bad problem worse. Look what it did to the air-traffic controllers, etc. If college graduates truly want to enter medical school and survive a residency, even if they are not the top of their class, then they deserve to be doctors. I do not see this as the dumbing down of American medicine. What about the implementation of the 80 hour work week? Government interference only serves to create more red tape and put the reins on free enterprise.

  • Flea

    It seems to me free market forces will drive medical graduates to fields of shortage. In primary care, if the shortages are long term they will be filled by nurse practitioners and physician’s assistants.

    No to the first, yes to the second.

    It’s a well-described phenomenon that physician distribution defies the third law of thermodynamics: we tend to congregate where there are lots of us already.

    The latter phenomenon is already occurring and will continue to occur.

    Meanwhile, MD-level PCPs will continue to fill their waiting rooms with kids who don’t need to be there in order to stay in business.

    best,

    Flea

  • Anonymous

    Medicine is NOT a free market

    The federal government, via Medicare, controls 50% of all healthcare dollars in the United States, giving them sufficient market share to assume de facto monopoly status.

    All insurance carriers base their payments to doctors on what Medicare pays.

    Thus, medicine is NOT a free market because the government has de facto control. NOt to the extent of socialized medicine, but enough to wipe out any semblance of a free market