Category: Physician Manpower

TH – Top News Article:
“The Georgia study suggests changes to insurance reimbursements hurt primary care by rewarding the delivery of diagnostic tests and medical treatments, instead of rewarding time spent communicating with patients.

‘What has happened with the physician payment system historically is that it has given a higher value to procedures over cognitive care,’ Hubbard said.

Family medicine physicians have the lowest average salary ($185,740) of the doctors studied, compared to radiologists and orthopedic surgeons, who had an average salary of more than $400,000.

‘When a medical student chooses a specialty, potential income is becoming more and more of a factor in that decision,’ Hubbard said.

Knox fears access to care could become restricted if a primary care shortage continues.

Physician assistants and nurse practitioners can fill some of the gaps left by a dearth of primary care physicians — to a point.

‘There is a higher level of qualification required to provide some of the services that physicians provide,’ Tracy said.

Pechous said the economics of training and retaining new physicians is complex.

The debt load facing medical school graduates is one of the impediments to enlarging the pool of primary care doctors. For M.D.s, that debt is pushing $130,000, Tracy said.

‘It is like a second mortgage.'”

Another interesting statistic:

“At the University of Iowa’s Roy J. and Lucille A. Carver College of Medicine, 37 percent of the incoming class entered the family medicine field in 1996. By 2006, that number had dropped to 10 percent. In the early 1990s, Iowa graduated nearly 45 family doctors per year. By 2006, that dropped to 12.”

Thanks to Dr. Pechous for writing this. The solution, really, is obvious. Pay more for the behavior you want and less for the behavior you don’t want. Higher reimbursement for primary care services, lower for procedures. This is not “class warfare” for physicians, it is simply facing simple economics and the consequences of reimbursement rates.

Doctor shortage worsens as student debt rises:

“the debt burden on graduates is daunting, especially given that they must spend at least three more years on post-graduate residency training that pays about $44,000 to $45,000 for the first year, according to the Association of American Medical Colleges.

While in their residencies, many future doctors choose to defer their school loan payments, so their arrears grow even larger as they accrue interest, Black said.
That option will be gone, however, beginning in July 2009, when the U.S. Department of Education ends medical school payment deferment — a move that could further put aspiring doctors in a financial bind, said Chromy, who helped author the resolution.

‘We’re required to do this residency, but we can’t defer,’ she said. ‘If we’re trying to increase the supply of physicians, the answer is not to make it harder to make physicians.’

The resolution estimates that the average monthly payment on debt of about $160,000 starts at $1,400 a month on a 25-year repayment plan — or about 50 percent of the post-tax income of a resident’s salary.

In his two years of medical school at Wayne State, Joseph Khouri has racked up about $140,000 in debt, a figure that includes out-of-state tuition and loans to pay for living expenses.

‘I mean, this is ridiculous,’ said Khouri, who is from Cleveland. ‘Medicine isn’t about money and it never was about it for me. But graduating $280,000 in debt is intimidating.’

It could be worse for future medical students at Wayne State Medical School. One report by the medical college association projects debt for graduates could rise to about $750,000 by 2033.”

This is the new social contract we have accidentally made. We tell our students to suck it up and pay extraordinary tuition to become doctors. Then we tell them they should be going into primary care, where they would be doing the most good caring for patients, but will never catch up to their peers in income, accumulation of home equity, retirement funds or wealth in general.

The saying that “it’s just as easy to fall in love with a rich man as a poor man” comes to mind. While in training, it is just as easy to fall in love with a handsomely reimbursed specialty as it is a poorly reimbursed one.