That’s a step in the right direction, and something a few institutions are trying.
Prospective doctors who graduate in excess of $200,000 in debt find the allure of a specialist salary too enticing to pass up. As this commenter notes, even if medical school were free to generalist physicians, “choosing to specialize can easily result in lifetime earnings $10 million higher than choosing primary care.”
Contrary to what Dr. Parks says, it’s not either this or “increasing the remuneration by a certain percentage points on office visit billing codes.”
We need to do both, and even then, it may not be enough to save primary care.
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Scholarships to pay the majority of the costs of medical school are available, through the military branches and the U.S. Public Health Service, and still go begging. There are still a few relatively affordable state-supported medical schools where the debt burden is reasonable (but more than in the past, admittedly.) There are loan forgiveness packages available from all levels of government. More money for medical schools will benefit medical schools, it will not make unspecialized care more affordable to practice and it will not help the problem of a shortage in “primary care.”
The problem isn’t due to the cost of education. The problem is due to the cost of practice. The problem is with behaviors of third-party insurers, public and private. The problem is that these payers don’t pay enough, limit charges below economically sustainable levels, and frequently fail to pay altogether. All the loan forgiveness and new scholarship money won’t make practice under these conditions more acceptable or significantly more sustainable. When overhead reaches levels of 65 or 70%, and Medicare programs cuts into its payments while limiting normal methods for fair recovery, like unlimited balance billing, free tuition will not really entice many to embrace a moribund business model. It is a bad deal either way with no relief in sight.
The simple fix, which will work better than throwing money at medical schools (who show little restraint at costs containment, and will be inclined to even less restraint with another open checkbook available to them) is to permit unlimited balance billing with Medicare. Patients can decide whether a doctor is worth the extra money they will be asked to pay out of pocket or not. The present scheme of price-fixing cannot work in an atmosphere of rising costs and minimal exposure to the real costs of consumption (and the present law does minimize exposure to costs of consumption by patients.) Nothing about the present system encourages thrift, restraint or even the desire to know what consumption actually costs.
Being the pessimist, I forsee this passing. The state governments will see it as a way out of supporting “state” medical schools and the medical schools will see it as a pool of “free money”, and the prospective students will not appreciate the nature of the bargain they have made until years after the last check to their medical school is cashed. By then, who knows? It won’t have helped the generalists in practice now, and it will hardly have made the practice of non-specializing medicine appear all that attractive (while the non-beneficiaries of this largesse struggle with their practices–those that still can, anyway.)
Let the Doc's & PA's control the specialty sector and the new Dr. NP's take over primary health care.
Even if this helps in the future, primary care will have long collapsed as those of us already in primary care will have been crushed by low payments, unfunded mandates, and ever increasing costs.
These new primary care only physicians can countersign (and take the lawsuits) for the midlevels they recruit to fill our place.
As a FP who went to a state-supported school and struggled for 6 yrs in pvt practice then finally took a job at an FQHC to get my loans paid, I think we need a combo of education reimbursement and increased salary/reimbursement. I still work at the FQHC because it is spiritually rewarding to me, but I have 5 kids I can’t afford to put thru even undergraduate school because my salary is so low……
I can’t imagine that I’d be unhappy with my FP job if I had no debt overhead.
As it is, I can’t wait to get out of it and I’m still in residency. I don’t want to sell my soul to my job…but to pay off my loans, that’s exactly what I need to do.
Don’t get me wrong, Secretwave, I am not unhappy with my FP job. It is why I stay and I find it tremendously rewarding on a personal level. I do alot of precepting of students (medical and PA mostly but some NP and DO) and try to pass on the many POSITIVE aspects of the field. They routinely say their rotation with us is among their favorites!
My point was that even though I had found a way to get out from under my debt (it took over 10 yrs), I still make about the same as the better paid pharmeceutical reps who call on me. I had hoped my kids wouldn’t have the burden of loans after college and (if they choose) grad school, but it will be unavoidable because I don’t make enough to help them enough……and I had so many kids, LOL, which of course was my choice and which I could NOT have done as a specialist!
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