Sunday, February 2, 2014

Why More Pay (Probably) Won't Create More Primary Care Physicians

There have been many, many calls recently to increase Primacy Care Physician(PCP) pay, and decrease that of Specialists. I'll link to just one example here. (The link in question also features some AMA RUC bashing, a topic I've covered before). This is part of a drive to lure more medical school graduates to Primary Care specialties such as Family Medicine and Internal Medicine.

(This can be a bit confusing, so let me explain for all those non-medical readers. Every doctor goes through medical school, and then selects a residency in a medical specialty. Everyone has to go through a residency in order to practice, with the exception of some military doctors. 4 medical specialties- Obstetrics and Gynecology, Family Medicine, Internal Medicine, and Pediatrics- are considered Primary Care specialties. They, in theory, will see patients first(primarily?), and either treat them or refer them to someone who will. Doctors in this field are called Primary Care Physicians, or PCPs. Doctors in every other specialty- General Surgery, Ophthalmology, Dermatology, etc.- are collectively referred to as specialists. There's one twist: Primary Care doctors can specialize in a sub-field and become specialists- for example: internal medicine doctors can do a fellowship in cardiology, and become cardiologists, who are specialists)

Primary care is widely reported to be in shortage- with many reports that we don't have enough PCPs to see patients. Thus the calls to increase pay to those fields. One problem: the number of primary care physicians is largely governed by the number of residency spots available. If there aren't enough family medicine residencies, there aren't enough family medicine doctors coming into practice each year. This is not a function of the number of graduating US medical students, because there are more than enough foreign medical graduates (FMGs) coming into the US. There FMGs went to medical school in their home country, but passed all of the requisite tests to practice here, and only need a residency spot in order to practice. This it is no surprise that in 2013, Family Medicine (the biggest primary care specialty) saw approx. 4000 applicants to approx. 3000 spots (Table 1 in the Research Report on Characteristics of Successful Applicants). In short, there were about a thousand doctors who wanted to go into family medicine, but couldn't because the government didn't fund enough residency spots.

More pay for PCPs will likely increase satisfaction, and may increase the percentage of US seniors that go into Primary Care, but it will not solve the Primary Care shortage.