Dec 5 Less than a quarter of new U.S. doctors
finishing an internal medicine training program planned to
become a primary care physician instead of a specialist - a move
that could worsen the primary care doctor shortage in some parts
of the country.
More people may need primary care doctors in the future due
to health care reform that gives more people insurance, said
authors of the study, which appeared in the Journal of the
American Medical Association.
Researchers at the Mayo Clinic in Rochester, Minnesota
analyzed surveys of close to 17,000 young doctors in the final
year of an internal medicine residency program. Just under 22
percent said they would become a primary care physician.
Another 64 percent wanted to be a specialist, most often a
heart or lung doctor or an oncologist. The rest hoped to work in
a hospital, or were undecided about their future.
Compared to responses by the same residents two years
earlier, changes in career plan into, or away from, general
internal medicine were both common.
"There have been recent estimates that in the next decade or
so, we may be as much as 50,000 primary care physicians short in
the United States," said Colin West, one of the authors.
That's due to a combination of factors, such as older
doctors retiring and more people getting insurance through
health care reform and needing a general doctor.
"Our study suggests that current numbers of graduates
planning general medicine careers won't come anywhere near
meeting that shortage," he added.
Some young doctors may graduate from medical school hoping
to be a primary care physician, but realize during residency
that it's much more lucrative to get into a speciality such as
cardiology or ophthalmology, said Amitabh Chandra, an economist
and health policy researcher at Harvard University.
Others might plan to be a specialist all along, but find it
easier to get into an internal medicine residency program than a
competitive speciality one.
Thus, training more internal medicine residents might not be
the answer to doctor shortages, researchers said. But Chandra
said another strategy could be to find ways to get current
primary care doctors into specific areas of the country that are
underserved - and to pay them slightly more to see more patients
and work longer hours.
"Ultimately... we just have to start to pay much more to
general internal medical physicians," he said.
Others have suggested that nurse practitioners and physician
assistants could fill the gap.
West said righting the primary care doctor shortage may
require system-wide changes.
"We really need to put much more attention into revitalizing
internal medicine and primary care as viable career options," he
(Reporting from New York by Genevra Pittman at Reuters Health;
editing by Elaine Lies)