Primary Care Workforce Situation: Not Hopeless

I sometimes observe that the only sector of the economy as messed up as health care is higher education, where the US has some great institutions but where costs are incredibly high and have been rising relentlessly for long periods of time. These two dysfunctional systems intersect in multiple places, one of which is the cost of medical school and its impact on the physician workforce.

One of the reasons the cost of health care is so high in the US is the overemphasis on specialists vs. primary care relative to other advanced countries. That overemphasis is a result of multiple factors, including a reimbursement system that favors procedures and the prestige associated with specialties. But another significant factor is the cost and financing of medical school. Average debt levels for graduating medical students are around $150,000. Combine that with leftover debt from college and it’s easy to get up into the $200,000 range. That’s a big nut to pay off in primary care where typical compensation is $150,000 per year or so.

That large debt level certainly encourages graduating medical students from going into primary care. My guess is it also deters some would-be primary care physicians from going to medical school in the first place.

Despite the challenges there is some good news on the primary care front. With match day just behind us, it appears that there is growth in the number of graduating medical students opting for primary care residencies. That makes the second year in a row with a significant increase and we should feel encouraged about that. My guess is that primary care is looking to new doctors like a more satisfying role while the specialties are seeming a bit more iffy. Also –based on my totally non-scientific observation, medical school now enrolls a larger percentage of people choosing the medical profession for the right reasons. Those who mainly want to make money are going into business and finance where they belong.

I’d really like to see something done about the cost of medical school. Since I’m assuming it’s futile to address tuition itself, I’d at least hope for an expansion of debt relief programs for those going into less lucrative specialties (mainly primary care) and committing to under-served geographic areas and settings. The Kraft family’s recent gift is a good example.

David E. Williams is co-founder of MedPharma Partners LLC, strategy consultant in technology enabled health care services, pharma,  biotech, and medical devices. Formerly with BCG and LEK. He writes regularly at Health Business Blog, where this post first appeared.

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  1. One of the reasons I myself did not go to medical school was simply because of the cost. I took the pre-med classes in college, took the MCAT, and then graduated from college. When I began looking at medical schools I could not believe what the cost was and how much debt I would accrue over a 4 year period. My parents had paid for my undergraduate degree and were not willing to pay for anymore schooling. I did have a passion for working with people and had always been interested in the medical field.
    Instead I chose to go to nursing school where I did get some decent scholarships. Now I am in graduate school getting ready to graduate with a family nurse practitioner degree. We are talking in class about how there are a lot of physicians leaving primary care and residents wanting to do specialities over primary care. The US may be facing a shortage of primary care providers where NPs can now pick up some of that slack. We work a lot with education and prevention as some of our main goals according to our scope of practice.
    But I do agree that the cost of medical school tuition should be adjusted to make it more appealing to college graduates who often go other directions due to costs. I think loan repayment programs and working in rural areas are some ways we the can help lessen these costs. There also seems to be more programs for nurses and APNs to get loan repayment and scholarships than for medical students. If there are enough properly trained primary care providers we can avoid a lot in healthcare spending down the road and avoid visits to specialists.

  2. That is great news about the increase in medical students opting for primary care residencies; hopefully this equates to an actual increase in the number of physicans who stay in primary care. As a grad student in nursing who is currently studying health care policy, primary care is an area that we have recently discussed as significantly lacking. Primary care, both for physicans and Advanced Practice RN’s is a huge need area. As you mentioned, tuition has increased (across the board). Incentives, such as tuition reimbursement, need to be placed to put healthcare providers in primary care, and possibly keep them there. I see this issue as more global than higher institutions however in regards to who is responsible.
    I agree that higher institutions force professionals to have to pay back their loans, but I blame our “system” for not valuing primary care and the education that we can provide. Ultimately, if PCP’s are doing their job, we save our tax-payers millions in not performing costly and unnecessary procedures. These millions that we save tax-payers can alleviate some of the financial burdens that many higher-institutions currently are experiencing.

  3. Well stated. Until medical schools work to make the education of primary care physicians more affordable, is it in our interest to encourage those for whom cost is a barrier to utilize programs in the Caribbean? Many do generate a large number of PCPs. What is your opinion of these schools?