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State Group Predicts Shortage of Primary Care Docs

Posted November 6, 2007

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— Physician shortages in North Carolina could grow in the coming years, according to a new study, as population growth and increased numbers of aging patients with chronic diseases put more pressure on the health care system.

The North Carolina Institute of Medicine conducted a far-reaching study on the shrinking supply of doctors and determined that the  shortfall in the number of needed primary care physicians will reach 25 percent statewide over the next 20 years.

"It's going to be very serious if nothing changes," said Pam Silberman, president and chief executive of the Institute of Medicine, an independent, nonprofit organization that provides analysis and advice on issues related to health and health care statewide.

"There are already almost 40 counties in this state that already have physician shortages," Silberman said.

Dr. Barbara Rowland, medical director for Piedmont Health Services, which runs clinics in many under-served areas of the state, already sees the impact of doctor shortages and said it's becoming very hard to recruit primary care physicians

"It's frightening," Rowland said. "At several of the sites, by the middle of the day, we're turning people away.

"I have never experienced this in my 18 years."

The problem results from a combination of more physicians nearing retirement and the difficulties medical schools have had to produce enough family doctors to meet the growing demand.

The Institute of Medicine has made various recommendations to head off the doctor shortage:

  • The University of North Carolina system is looking at expanding medical schools in Charlotte or Asheville with a focus on recruiting more primary care docs.
  • More physician assistants and nurse practitioners could be used.
  • Programs could ensure more medical residents stay in North Carolina for their careers.

Several students at the UNC School of Medicine in Chapel Hill told WRAL they were interested in specialties like oncology, sports medicine and anesthesiology, rather than family practice medicine.

"I have family members that are in primary care. That's one of the (people) telling me don't go into family medicine because you're working really hard for the amount of money you get," medical student Lea Harrell said.

"Primary care is at the bottom end of the pay scale," student Matt DeAugustinis said.

"With insurance, they're trying to pay them less and get more out of the doctors," student Rob Thompson said.

Silberman called the growing shortage of primary care physicians a matter of economics, noting many medical school students are more than $100,000 in debt when they graduate.

"You can get a lot more money if you go into a specialty than if you go into primary care," she said.

In some cases, surgeons are also in dwindling supply, and shortages are also projected in psychiatry and obstetrics, according to the Institute of Medicine study.

"This is an issue. We can't wait until we're in a crisis to solve because medical training takes a long time before you produce the doctors who are going to be out on the street," Silberman said.

25 Comments

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  • Dominion Nov 7, 2007

    The universal healthcare debate is killing me. Does ANYBODY really think for a second that universal healthcare would be a successful program in the U.S.?? Look at social security! We all see where that's going! And there is the issue of the waiting lists as FairPlay mentioned. I don't know about you, but if I need some sort of urgent surgery, I don't want to be on a waiting list forever waiting for it. Social programs are NOT the answer. If social programs worked so well, communism would work somewhere other than just on paper. Good intentions don't solve problems.

  • FairPlay Nov 7, 2007

    razor... I disagree. It is not the work they do, it is the lack of nutrition education and health education. A problem to teach because they won't learn English.Look at what they eat and too much drinking and smoking. As a nurse at an ER I can tell you most of the check ins are their kids and wives and late night alcohol accidents. I have yet to see a work injury.

  • UNC Doc Nov 7, 2007

    Reimbursement is a huge problem. 2 students go to medical school, both come out with >$100,000 in debt. One goes into pediatrics and the other goes into radiology. The residencies are both three years long, but the pediatrician's is much more rigorous, and also her hours are more demanding when she gets out into practice. The radiologist makes on average at least three times what the general pediatrician makes, yet the pediatrician also carries the same amount of debt. It isn't rocket surgery to see why primary care medicine is less appealing from a lifestyle standpoint.

  • ars Nov 7, 2007

    Low reimbursement is really the problem here. One cannot attract doctors into this field if there is no reward. The med students said it all--- primary care docs work really really hard and are not compensated appropriately for their efforts. Not to put down any professions, but consider this: an electrician or beautician or plumber earns more per hour than a primary care doctor does. The primary care doc has 11 more years of education and training than these folks, and actually can save a life. Why does our society feel it can set ridiculously low limits on compensation for such an important contribution to our society, while the free market prevails with other professions which don't nearly add as much value? (And, no, I'm not knocking electricians, etc.. they actually do a useful service; I'm talking about lawyers and paper pushers.)

    Govt-run healthcare will lower compensation even further, and will suck primary care of any future doctors.

  • jgirl5830 Nov 7, 2007

    razor, what about the families of these workers? They are the ones going to the ER for free tylenol when pedros' nose is running and has a little fever, they have no health insurance therefore they cannot go to a regular doctors office because they would have to pay for the visit up front, so they use the ER for all of their needs never paying a dime, which is then passed down to you and I, and the wait times have gone nuts because of it also.

  • NeverSurrender Nov 7, 2007

    "You won't have to go to the emergency room for every little ailment,"

    ---

    Unfortunately right now there is no deterrent to going to the ER as a PCP due to COBRA. The people abusing the system know they shouldn't be there but they know the likelihood they will be caught out is next to nil. And that's with most of these people who abuse the system getting paid under the table in cash but yet they'll cry poverty when they come in the hospital or GP's door.

    I would support amending COBRA to allow hospitals to enforce collection of $750/visit to the ER when they come in to get the million dollar workup for the sniffs and sniffles with the fee being waived if you truly have an emergent situation.

    Make a few public examples of the bogus frequent flyers and I assure you that the queues will be gone bloody quickly.

    I'm not against those who need care getting it...I'm against those who abuse the system, know they're abusing it, and just don't care ruining it for those of us who do pay.

  • razor Nov 7, 2007

    so does anyone actually HAVE an answer to the healthcare problem?

  • razor Nov 7, 2007

    the reason for the burden of these "illegals" is because of the nature of the work they perform. If white people were performing the same types of jobs in the same frequency you'd see the same number of white people there. And trust the triage nurses in the er, they know what they're doing. Some people just need medical attention immediately, ie, patients with chest pain, so don't be offended if you have a long wait.

  • jgirl5830 Nov 7, 2007

    @ captainawesome "free health care is the answer" and whom do you think the funds will come from to pay for this "free" health care? I do NOT want the Governments hands in healthcare, it will only get worse, and we will still be paying for it through our taxes, yet another entitlement program for the illegals on the backs of the American tax payers, no sir, that is not the answer.

  • BUCKEYEnNC Nov 7, 2007

    OK many illegals use the ER for their health care. Primary Care Physicians (PCPs) can turn away patients who do not have the means to pay unlike the ERs.

    Unfortunately we are seeing the power of money at work here. If you are about to graduate from Med school with over 100k in student loan debt, you have to go where the money is.

    No one is blaming old people. Blame Medicare, health insurers and the gov't. Insurance companies and medicare place limits on how much a doctor can charge for their services. There is only so many hours in the day.

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