* More incentives needed for primary care doctors
* Most medical graduates choose better paid specialties
By Andrew Stern
CHICAGO, July 23 (Reuters) - A growing shortage of primary care doctors could place a major burden on the U.S. healthcare system if President Barack Obama succeeds in extending medical insurance to millions of Americans who currently lack it.
As healthcare legislation works its way through the U.S. Congress, most of the focus has turned to how to finance a reform that could cost $1 trillion in the next 10 years and aims to cover most of the 46 million uninsured Americans.
Less attention has been paid to what might happen if millions of new patients join a healthcare system that is unprepared and unequipped to handle the load.
The United States already has a shortage of between 5,000 and 13,000 primary care doctors, according to the Robert Graham Center. Add millions of previously uninsured people and the shortfall will balloon to as many as 50,000 doctors.
"I don’t think (the doctor shortage) will be the thing that dooms the reform bill" being debated in Congress, said Dr Robert Phillips, director of the Robert Graham Center, a non-profit organization that analyses healthcare policy.
Obama and other reform advocates argue that billions of dollars and many lives could be saved by extending preventive care to many who do not now have access to it.
But some lawmakers worry that such gains may not be realized because of a lack of primary care doctors who are usually patients’ first healthcare contact.
Solving the problem will take time and money.
"It’s a system that’s not serving our country well; we need transformative change and it’s going to cost money," said Dr Cecil Wilson, president-elect of the American Medical Association, which represents 250,000 doctors.
The country needs more medical schools, more residency slots, and better pay for primary care physicians who currently make much less money than specialists, Wilson said.
Insurers routinely pay more for procedures performed by specialists than for checkups by primary care doctors. A primary care physician typically earns between $125,000 and $200,000, while specialists often earn several times more.
Some experts argue the problem is more an inefficient healthcare system than a shortage of doctors.
POOR AREAS UNDERSERVED
The Altarum Institute, another non-profit group that analyses medical policy, found affluent areas of cities tend to have plenty of primary care physicians, while poor urban areas and rural regions are underserved.
There is also a perceived shortage of nurses, who may be called upon to take on more tasks when preventive care becomes the norm.
Congress is weighing incentives for primary care physicians, such as bumping up payments for primary care services by 5 percent from the government-run Medicare program, and writing off medical school debt in exchange for service in the National Health Service Corps, which places doctors in underserved areas.
But expanding the ranks of primary care doctors could take years — if the incentives work at all. Phillips said primary care doctors’ Medicare compensation will have to be raised by 50 percent to have an impact.
Primary care doctors — family physicians, pediatricians, and general internists — comprise one-third of the 682,000 U.S. doctors, about the same proportion as two decades ago, but their numbers are seen dwindling as retirees are not replaced.
Of the 18,000 U.S. medical school graduates each year, a growing number are choosing to enter specialties such as cardiology, gastroenterology or plastic surgery.
At Northwestern University’s Feinberg School of Medicine in Chicago, only 5 percent of students overseen by primary care physician Dr Russell Robertson are interested in becoming family doctors. The trend is damaging healthcare, he said.
"When primary care providers exceed the number of specialists treating patients, healthcare outcomes are better across the board. And by a positive coincidence, healthcare costs are lower," Robertson said.
Feinberg medical student Jacob Chacko said his classmates are choosing which practice to pursue based on perceived job satisfaction and nagging worries about how to repay skyrocketing school loans.
"We know there is intense demand for primary care physicians but most medical students hope, possibly naively, that they will be in demand no matter what they go into," Chacko said.
(Editing by Alan Elsner)