Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Why the primary care physician shortage is overblown

Peter Ubel, MD
Physician
March 14, 2013
171 Shares
Share
Tweet
Share

Are there really too few primary care physicians? And if so, what can we do to solve the PCP shortage? The standard answer to the first question is “yes, we have too few PCPs.” And the standard solution is to train more such docs, or allow more foreign-trained primary care docs into the country or, better yet, simply pay PCPs more money, so that graduating medical students will be more likely to pursue such careers.

I have a different set of answers. To the first question, of whether we have a PCP shortage, my answer is: “Maybe yes, but very possibly no.”

Keep in mind, before you rush to judge my answer, that I am a proud primary care physician, trained in general internal medicine. Coming out of residency, I was happy to achieve lower pay than my subspecialty colleagues in order to experience the pleasures of taking care of “the whole patient.”   I also finished medical school all the way back in 1988, when the expense of such schooling (especially a state university like the one I attended) didn’t burden me with six figure debt.

Keep in mind, also, that I think primary care is crucial to offering high quality, affordable medical services to people. I’m a HUGE fan of primary care. And I think way too few patients in the U.S. have access to good primary care.

So how could my answer to whether we have a PCP shortage be “very possibly no”?

Because of that last “P” in “PCP”—the P for “physician”. We need to think more clearly about whether it is more primary care physicians that we need or, instead, more primary care clinicians: nurse practitioners, physician assistants and the like.

Take the growing gap between medical school graduation numbers and residency slots, as captured in this picture from Sarah Kliff at the Washington Post:

jaws-of-death

Medical school graduates call this gap the “jaws of death.” The problem it highlights is that hospitals have not grown residency positions as quickly as they have grown medical school slots. In part, this is because the federal government funds many residency positions, and such funding has stagnated.

To address this gap, the Affordable Care Act (aka “Obamacare”) put $167 million toward funding new residency slots under its Primary Care Residency Expansion program. (Sarah Kliff writes more about that here; she is a MUST read for anyone interested in US healthcare policy.)

I’m happy about this funding, and think it will help address these two problems, of primary care shortages and the jaws of death.

But it won’t solve either problem. And that is why, to help promote primary care, I’d love to see more PCPs adopt an anesthesiology model of practice. Here is what I mean by such a model.

In many operating rooms today, the majority of anesthesia will be handled by a nurse anesthetist, under the supervision of an anesthesiologist.  In some cases, that will mean that one physician anesthesiologist will be “running” 2, 3, maybe even 4 operating rooms at a time. The anesthesiologist will have devised the anesthesia protocol for each patient. The anesthesiologist will be there for the trickier parts of the operation: the induction of anesthesia, for example, or any part of the operation where the patient’s vital signs fluctuate.  But given that most patients, especially those with low risk operations, fly through anesthesia without any complications, nurse anesthetists are able to handle most of the care without a hitch. Meanwhile, the anesthesiologists make a very nice living, since they are able to take responsibility (and therefore bill) for more patients.

Many primary care clinics already weave together physicians, physician assistants, nurse practitioners and registered nurses. I am just raising the possibility that if we do more such weaving, we can reduce the primary care gap.  Linda Green made a related argument in a recent Health Affairs paper.

I think this model could be a much more attractive way for physicians to practice primary care.  First, it would mean that many more routine visits would be handled by non-physicians. And for all of the joys of practicing primary care medicine, you have to realize—it can get routine. Most primary care physicians would probably be happy to spend a higher percentage of their working time taking care of more complex primary care needs than adjusting blood pressure medicines and treating colds.

Second, this model could increase primary care physician pay. By seeing more patients per hour, such doctors would be able to bill for more patient visits.

Third, it means getting more trained primary care clinicians, of all varieties, in front of needy patients. It reminds us that it is primary care that is in shortage, not necessarily primary care physicians.

When I practiced in the VA setting, I had the great pleasure of working closely with many excellent nurses, nurse practitioners and physician assistants. Together, we were able to offer a standard of care that experts say matches or beats the care most Americans receive.  If primary care practices more aggressively adopt an anesthesia model, we might simultaneously expand access to primary care while improving the quality of the care we provide.

Peter Ubel is a physician and behavioral scientist who blogs at his self-titled site, Peter Ubel and can be reached on Twitter @PeterUbel.  He is the author of Critical Decisions: How You and Your Doctor Can Make the Right Medical Choices Together.

Prev

10 ways to make EMRs more doctor-friendly

March 13, 2013 Kevin 14
…
Next

The importance of saying goodbye at the end of life

March 14, 2013 Kevin 17
…

Tagged as: Primary Care, Public Health & Policy

Post navigation

< Previous Post
10 ways to make EMRs more doctor-friendly
Next Post >
The importance of saying goodbye at the end of life

More by Peter Ubel, MD

  • Clinicians shouldn’t be punished for taking care of needy populations

    Peter Ubel, MD
  • Patients alone cannot combat high health care prices

    Peter Ubel, MD
  • Is the FDA too slow to handle the pandemic?

    Peter Ubel, MD

More in Physician

  • From rural communities to underserved populations: How telemedicine is bridging health care gaps

    Harvey Castro, MD, MBA
  • From solidarity to co-liberation: Understanding the journey towards ending oppression

    Maiysha Clairborne, MD
  • Finding peace through surrender: a personal exploration

    Dympna Weil, MD
  • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

    Katrina Gipson, MD, MPH
  • Beyond the disease: the power of empathy in health care

    Nana Dadzie Ghansah, MD
  • How to overcome telemedicine’s biggest obstacles

    Harvey Castro, MD, MBA
  • Most Popular

  • Past Week

    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • From physician to patient: one doctor’s journey to finding purpose after a devastating injury

      Stephanie Pearson, MD | Physician
    • Breaking the cycle of misery in medicine: a practical guide

      Paul R. Ehrmann, DO | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Why are doctors sued and politicians aren’t?

      Kellie Lease Stecher, MD | Physician
  • Recent Posts

    • From rural communities to underserved populations: How telemedicine is bridging health care gaps

      Harvey Castro, MD, MBA | Physician
    • 5 essential tips to help men prevent prostate cancer

      Kevin Jones, MD | Conditions
    • Unlock the power of physician compensation data in contract negotiations [PODCAST]

      The Podcast by KevinMD | Podcast
    • From pennies to attending salaries: Why physicians should teach their kids financial literacy

      Michele Cho-Dorado, MD | Finance
    • From solidarity to co-liberation: Understanding the journey towards ending oppression

      Maiysha Clairborne, MD | Physician
    • Changing the pediatric care landscape: Integrating behavioral and mental health care

      Hilary M. Bowers, MD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 44 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Cholera Outbreak Widens; What Beethoven's DNA Revealed; Grindr's Free HIV Tests
  • FDA Panel Supports Tofersen for Rare Genetic ALS
  • Pregnant, Black? Here's Your Drug Test
  • Progestin-Only Birth Control Linked to Small Increase in Breast Cancer Risk
  • Fatty Acid Tube Feeding May Backfire for Preemie Breathing Disorder

Meeting Coverage

  • Outlook for Itchy Prurigo Nodularis Continues to Improve With IL-31 Antagonist
  • AAAAI President Shares Highlights From the 2023 Meeting
  • Second-Line Sacituzumab Govitecan Promising in Platinum-Ineligible UC
  • Trial of Novel TYK2 Inhibitor Hits Its Endpoint in Plaque Psoriasis
  • Durable Vitiligo Responses With Topical Ruxolitinib
  • Most Popular

  • Past Week

    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • From physician to patient: one doctor’s journey to finding purpose after a devastating injury

      Stephanie Pearson, MD | Physician
    • Breaking the cycle of misery in medicine: a practical guide

      Paul R. Ehrmann, DO | Physician
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • Why are doctors sued and politicians aren’t?

      Kellie Lease Stecher, MD | Physician
  • Recent Posts

    • From rural communities to underserved populations: How telemedicine is bridging health care gaps

      Harvey Castro, MD, MBA | Physician
    • 5 essential tips to help men prevent prostate cancer

      Kevin Jones, MD | Conditions
    • Unlock the power of physician compensation data in contract negotiations [PODCAST]

      The Podcast by KevinMD | Podcast
    • From pennies to attending salaries: Why physicians should teach their kids financial literacy

      Michele Cho-Dorado, MD | Finance
    • From solidarity to co-liberation: Understanding the journey towards ending oppression

      Maiysha Clairborne, MD | Physician
    • Changing the pediatric care landscape: Integrating behavioral and mental health care

      Hilary M. Bowers, MD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Why the primary care physician shortage is overblown
44 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...