Report shows shortage of primary care doctors

The number of U.S. medical students choosing internal medicine residencies inched higher from 2009, but not enough to significantly impact the shortage of primary care physicians, according to the 2010 National Resident Matching Program report.

The report shows 2,722 U.S. seniors at medical schools enrolled in an internal medicine residency program, which is a 3.4% increase from 2,632 in 2009. The internal medicine enrollment numbers are similar to 2008 (2,660), 2007 (2,680) and 2006 (2,668). In comparison, 3,884 U.S. medical school graduates chose internal medicine residency programs in 1985.

The 2010 match numbers include students who will ultimately enter a subspecialty of internal medicine, such as cardiology or gastroenterology. Currently, about 20% to 25% of internal medicine residents eventually choose to specialize in general internal medicine, compared with 54% in 1998.

With more people gaining access to affordable coverage and an increasing elderly population, America will need more general internists and other primary care doctors than the primary care physician supply, according to the American College of Physicians (ACP).

Increasing Medicaid and Medicare payments to primary care physicians, expanding pilot testing and implementation of patient-centered medical homes, and increasing support for primary care training programs are ways to increase the number of primary care physicians.

There are two tracks that need to be pursued to make primary care specialties more competitive with other specialties, says Bob Doherty, senior vice president, Governmental Affairs and Public Policy, ACP.

“One is to increase how much they are paid by Medicare, Medicaid and private payers under traditional fee-for-service - that is, increasing the relative value units and payments for office and hospital visits by primary care physicians would be a significant step forward toward parity with other fields,” Doherty says. “The new health reform legislation increases both Medicare and Medicaid payments for office visits by primary care physicians, but it will be important that private payers ‘match’ or even increase those amounts in their own fee schedules. Congress will also need to extend and likely increase the primary care pay increases under traditional FFS Medicare and Medicaid over the amounts in the legislation in order to substantially impact career choice.”

The second track is to implement models that move away from paying primary care doctors on a fee-for-service basis, to ones that align incentives with the value of care provided. Doherty notes specific examples, such as paying primary care physicians for coordinating care of patients in a patient-centered medical home and for achieving better outcomes, or paying primary care physicians more who work collaboratively with hospitals to reduce preventable admissions and re-admission rates under a “shared savings” model.

“Many health policy experts believe that this second track will ultimately have a bigger positive impact on primary care than just increasing traditional fee-for-service,” he says.