Strike one, Strike two, Strike three....

It’s true that we need specialists for complex chronic diseases. But, with recent projections like

• There will be a generalist physician shortage of 35,000 to 44,000 by the year 2025 (Health Affairs) and

• Just 2 percent of graduating medical students are choosing to enter general internal medicine (The Journal of the American Medical Association),we can’t afford to have shortages of them in total physician workforces. And, we can’t take this issue lightly.

What will be the consequences of these projected shortages for patients?
According to the Health Affairs report, either primary care doctors will be seeing many more patients than they do now, or several million people will be without a primary care doctor, no matter how accessible health care might be for the rest.

Strike one

To look into perspective of primary care physicians, as Tim Norbeck, the executive director of the Physicians’ Foundation, has said of a study of survey on 12,000 physicians, (majority of whom are primary care physicians); "Doctors feel they can’t spend enough time with their patients because of the paperwork and red tape hassles.” In the study, nearly half of them said they planned in the next three years to reduce the number of patients they see or to stop practicing altogether. Over three-quarters felt they were at “full capacity” or “overextended and overworked.”

Strike two

The health care reform will not be successful without adequate number of primary care physicians and effective primary care system. The crisis in primary care must be addressed before any real health reform changes can occur; otherwise, the flood of new patients may instead turn out to be a final strike for our ailing health care system. Take a look at the situation in Massachusetts for example. Since a landmark law was enacted in 2006, which mandate requirement of health insurance for nearly all residents, the state has struggled to provide primary care to the estimated 440,000 newly insured.

As New York Time has posted in December 11, 2008,

“People can survive one organ system failing and even two,.........but when that third one goes.....”

And, at that point for all of us, doctors and patients, the game would be over.

Possible solution

In an attempt to prevent the potentially devastating public health implications of primary care physician shortages, the American Medical Association is currently vowed to support financial incentives for medical students who choose to go into primary care.

And, personally, I think physician payment reform and reduction of the amount of payment discrepancies between specialists and primary care physicians are needed to be done.