The Senate health reform bill proposes to add 2,000 residency slots, in the hope to increase the number of primary care doctors and general surgeons.

I’m going say right now, that isn’t going to work.

Similar in concept to building more medical schools, nothing is going to change the skewed generalist:specialist ratio unless the professional incentives of each field changes.

And I’m not just talking about money, although that’s a huge factor.

The lifestyle, hours, and bureaucratic requirements all are significantly more favorable, in general, for specialists. The physician burnout rate for primary care is at all-time highs, and only rising.

Furthermore, most residents who enter internal medicine or general surgery residencies pursue sub-specialties, rather than generalist care.

So unless there’s language in the health reform bills that significantly improves the professional satisfaction of primary care doctors, along with minimizing the pay disparity, adding more residency slots or medical schools will simply lead to more specialists.