The Dallas Morning News is reporting the closing of a family practice physician in today’s edition; “High prices, red tape fuel popular Dallas doctor’s move to Temple.”
Why would the only daily paper of the 9th largest city in the US be reporting on such a seemingly trivial development in the Sunday edition of the newspaper? Because they can clearly see that if dedicated doctors like Dr. Bill Walton are leaving the ranks of stand alone Family Practice physicians, then it can only be a short time until we have a major problem over the lack of family practice physicians in the US. Could Dr. Bill Walton be the canary in the coal mine?
Why should the average citizen be concerned about Dr. Bill Walton? Because Family Practice doctors are the only doctors that are trained to look at the patient wholistically and make assessments based on the whole view of you as a patient not a single episode. Think of the Family Practice doctor as the quarterback of your health care; they know when to get tests, refer you to a specialist or give you a prescription. The Specialist is like a center on the offensive live, sure they are strong and know how to snap a football, but you don’t want them making a pass or calling an audible with one minute left on the clock.
Real Life Example: I know of a patient who was diagnosed with a rare case of lymph node cancer, so she found the best lymph node oncologist in the US and he saved her from lymph node cancer. However, three months later she was dead. From liver cancer. The lymph node oncologist is trained to look at the lymph nodes, not the rest of the body.
Why is there a shortage of Family Practice doctors?
According to the Sept 9 issue of Journal of the American Medical Association
- Family medicine had the lowest mean salary ($185,740) and the lowest percentage of filled residency positions (42.1%) among U.S. graduates.
- The highest mean salaries were in radiology ($414,875) and orthopedic surgery ($436,481); those specialties also had the highest percentage of filled allopathic residencies (88.7% and 93.8%, respectively).
- The mean starting salary of a radiologist was 2.7 times that of a family physician.Residency fill rates in emergency medicine (79.7%), otolaryngology (93.0%), and pediatrics (72.8%) were slightly higher than would be predicted by their salaries ($255,530, $327,399, $185,913, respectively).
I think that DB’s Medical Rants spells it out correct in this assesment:
Boys and girls, this is not rocket surgery or brain science. Fourth year medical students make career decisions based on many factors, and money may be the most important factor. I hate that money is that important, but it really is.
Our health care payment mess induces students to make career decisions using the wrong parameters.
Back in the 1970s, when I was a medical student and resident, internal medicine was the most competitive field, and fields like dermatology, radiology, anesthesiology and orthopedics [the ROAD] were easy to enter. What happened to change this – Medicare and especially the RUC. Our payment structure has no rationale. CMS pays for episodes in a rather arbitrary manner. They have not thought through the implications of how physicians are paid.”
According to this New York Times Article “Doctor Shortage Proves Obstacle to Obama Goals”
“Obama administration officials, alarmed at doctor shortages, are looking for ways to increase the supply of physicians to meet the needs of an aging population and millions of uninsured people who would gain coverage under legislation championed by the president.
To cope with the growing shortage, federal officials are considering several proposals. One would increase enrollment in medical schools and residency training programs. Another would encourage greater use of nurse practitioners and physician assistants. A third would expand the National Health Service Corps, which deploys doctors and nurses in rural areas and poor neighborhoods.
Senator Max Baucus, a Montana Democrat and chairman of the Finance Committee, said Medicare payments were skewed against primary care doctors — the very ones needed to coordinate the care of older people with chronic conditions like congestive heart failure, diabetes and Alzheimer’s disease.“Primary care physicians are grossly underpaid compared with many specialists,” said Mr. Baucus, who vowed to increase primary care payments as part of legislation to overhaul the health care system.”
The need for more doctors comes up at almost every Congressional hearing and White House forum on health care. “We’re not producing enough primary care physicians,” Mr. Obama said at one forum. “The costs of medical education are so high that people feel that they’ve got to specialize.” New doctors typically owe more than $140,000 in loans when they graduate.
Lawmakers from both parties say the shortage of health care professionals is already having serious consequences. “We don’t have enough doctors in primary care or in any specialty,” said Representative Shelley Berkley, Democrat of Nevada.
Senator Orrin G. Hatch, Republican of Utah, said, “The work force shortage is reaching crisis proportions.”
The Association of American Medical Colleges is advocating a 30 percent increase in medical school enrollment, which would produce 5,000 additional doctors each year(check calculation)
The situation is even worse in some rural areas. Dr. Richard F. Paris, a family doctor in Hailey, Idaho, said neighboring Custer County had no doctors, even though it is larger than the state of Rhode Island. So he flies in three times a month, over the Sawtooth Mountains, to see patients.
Folks, we are in for a long ride in healthcare regardless of what is in this health care “reform” bill.
