The front line of medical care—primary-care doctors—is crumbling as med-school grads opt for better pay and a more predictable life.
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One result of too few or too busy primary-care physicians is that patient visits to emergency rooms, even by insured patients, will increase, only adding to the overall expense of health care for all.
The CSMS report does offer the silver lining that in 2010 medical schools nationally saw an increase in the number of graduates choosing primary care. The new medical school at Quinnipiac University might make a little difference. Still, it will take at least five years before any new graduates complete residencies and join the workforce, assuming they stick with their initial choice, and further assuming that enough of them will want to practice in Connecticut.
“The question becomes, ‘How do we get them to Connecticut?’” says Geragosian. “There are 49 other states out there competing against us. What is Connecticut willing to do to make this state attractive to these young physicians?”
The malpractice issue is an area the state legislature has considered from time to time, and might again. According to the American Medical Association, Connecticut remains one of the “crisis states” when it comes to medical malpractice insurance rates.
“In 2000, for an internist, the average medical malpractice cost was $7,736,” says Geragosian. “In 2007, that was $34,700. That’s a 349 percent increase that put us third in the country. While the increases have slowed, they haven’t decreased significantly” since 2007.
In the meantime, the problem of disappearing docs continues to build.
As McLean puts it, “You’ve got [primary-care physicians] who are 50 or 60 saying, ‘You know what? I’ve just had enough. I don’t want to transfer over to electronic medical records. That’s a complete redo of my life. I’m not going to put in the expense when the payback on that is too long. I’d rather just retire early.’ And the pipeline is dry.”
“One of the biggest things is trying to get more people wanting to go into primary practice,” Maresh says. “There are a lot of older physicians who are retiring [43 percent of them in Connecticut are over 50] and if we don’t have more people to fill the void, as well as the growing need of the population, there’s going to be a severe shortage.”
Various studies show that in areas where there are high ratios of primary-care physicians, patients are the winners. “They have fewer hospitalizations. They have fewer complications,” McLean says. “The data is overwhelming that the more primary-care docs you have taking care of a given population, the better the outcomes and the less expensive the care.”
A lot of students go into medical school thinking about primary care,” he says. “And then it changes. Maybe the people they get exposed to as role models seem too busy, and relatively unhappy at times, and work long hours doing lots of paperwork that they’re not getting reimbursed for. Then [the med students] look over at some of the subspecialists who they see are working fewer hours and doing maybe more sexy things. It looks easier, though it may take more years to get there. So in terms of prestige and income and lifestyle, the primary-care guys look like they’re working too hard for what they’re getting paid.”
Despite the challenges and frustrations, most primary-care physicians remain generally satisfied with their calling, according to the medical-society survey.
“There are benefits to primary care, especially here in Connecticut,” says Geragosian. “In most cases, you’re your own boss. You develop relationships with families that can extend for generations. Your financial rewards are not going to be that of certain other specialties, but there are other kinds of satisfaction. Pediatricians are the most satisfied of those practice groups even though they are across the board the lowest-paid.”
“It’s very satisfying,” agrees pediatrician Carbonari. “You do not go into primary care because you want to play golf at the country club and because you want a nice yacht or to take nice vacations. It’s just really cool when you run into somebody and they say that you really made a difference. You think, ‘Okay, for all the times when you’re not happy about things in the profession, that makes it worth it.’ I know it sounds corny, but there are a lot of kids who go into medicine for that reason. They want to do some good, they really do.
“You develop good relationships with families,” Carbonari continues. “And you’re with them through the hard stuff and the good stuff. That’s very fulfilling. If that’s the kind of thing that gets you, then primary care is where you belong because you can truly make a lasting difference.”
That’s a compelling sentiment, but are enough future doctors listening?