The Wall Street Journal reports on increasings shortages of physicians, especially in primary care, which generally pays less than many specialties. While this is a current issue and problem, the challenge may be exacerbated by health reform, which will increase access to health care while not addressing the supply side. Another reality of the health care force is the declining hours being worked by many physicians as compared to the past. This is a result of many factors, including shifting priorities of some physicians, especially women, who now comprise about half of medical school classes. More flexible and balanced working arrangements demanded and practiced by those in their family raising years has an impact upon overall availability.
When I was in training, awareness of disparate incomes of specialties vs. primary care was not in the general awareness of most students, or if it was, did not seem to lead the practice decisions of many. Today there is heightened awareness of earning potential and a flight toward specialties and away from primary care.
I believe it likely that this shortage will lead to many creative and regulatory changes, including an increase in the use of mid-level practitioners for routine matters, including nurse practitioners, physician assistants and the like.
agree with your comments about the shortage of physicians. My proposal is simple. Experienced nurse practitioners and PAs can handle most of what primary care physicians do–even if we won’t admit it. I recommend staffing most primary care clinics with NPs and PAs, along with providing increased funding for the training of these professionals. NPs and PAs represent a much more cost effective solution than training more MDs, many of whom will succumb to the draw of highly paid specialties. I do not think we as a society will allow reduced reimbursement for specialists in exchange for increased reimbursement for PCPs. Look at the stink the American Cancer Society made when a reimbursement change was being considered for oncologists.