Where in the World Can We Find More Primary Care Physicians?

Apparently I’m not the only one with Neil Diamond’s “Coming to America” stuck in my head. Jacob Goldstein of WSJ’s Health Blog writes about the very real possibility that Canada would lose primary care doctors to the United States if universal health care is enacted – a big concern for the Canadians. He also refers back to an earlier post about how the number of residency slots in primary care has fallen at the same time as the number of international doctors filling those slots has shot up.

Give me your tired pediatricians, your poor family practice doctors, your huddled masses of internal medicine MDs yearning to breathe free! No, seriously. Give them to me. Because if we achieve universal health care, the demand will go through the roof.

Most economic models suggest that the uninsured use health care at about half the rate that the insured do -- and then equal to that rate when they get coverage. One area that automatically gets axed when you don’t have coverage is primary care. What happens when you finally get coverage? You want to choose your own doctor and get yourself checked out. Sure enough, that’s what happened when Massachusetts phased in its universal health care plan – the already high demand for primary care physicians far exceeded what was available. What good is universal access if you can’t actually see a doctor?

This is one area where bringing in doctors from other countries can only help so much. The incentives for American medical students to become a primary doctor just aren’t what they used to be. You have to see more patients, work longer hours, and get paid substantially less than specialties like dermatology, radiology or anesthesiology. As KevinMD points out, we’re seeing a similar trend with surgeons – the number of general surgeons is on the decline, but the number of cosmetic surgeons is doing fine. We can’t ignore that economics plays as large a role as lifestyle, with the New England Journal of Medicine reporting that reporting that 23% of medical school graduates carry a debt burden of $200,000 or more.

We know what ails us. We need to expand programs like the National Health Service Corps, we need to find better compensation and more support for primary care physicians, we need to fund and train more nurse practitioners and physician assistants who can pick up the primary care slack, and we need to train up-and-coming medical students on how to integrate their practice of medicines with NPs and PAs. And we need to do it yesterday -- because giving all Americans the means to afford health care in the next two years is useless if we don’t have create enough doctors and nurses to dispense the care now.

(Photo credit:  Brian Auer on Flickr.)