It can sometimes seem impossible to find a primary care physician in your area who’s covered by your insurance, but the issue may be larger than out-of-network versus in-network issues, a new study reports. The percentage of medical students who go into general, internal medicine has dropped precipitously in the past 20-some years, while a simultaneous increase in chronically ill baby boomers -- coupled with what researchers refer to as an obesity epidemic -- means that demand is way up.
Ultimately, there may not be enough primary care physicians to treat patients in the U.S.
Writing in the Archives of Internal Medicine, Dr. Mark D. Schwartz of NYU’s School of Medicine, and other researchers, compared data compiled from more than 2,000 medical school seniors. In 1990, 9 percent indicated that they planned to pursue training in general, Internal Medicine. But by 2007, that number had fallen to fewer than 2 percent.
Overall, the number of respondents who indicated that they planned to go into internal medicine (including general internal medicine, as well as sub-specialties and pediatrics) also declined, though less dramatically. Some 24 percent indicated this was their plan in 1990 versus 23 percent in 2007.
When exploring what could be behind the declines, researchers focused on two main factors: “workload and stress” and “opportunity for meaningful work.”
In both 1990 and 2007, some 70 percent of surveyed students reported that they believed internal medicine had higher workload and stress levels than other specialties. But when it came to perceptions of whether or not the work was meaningful, 58 percent indicated that internal medicine gave them a good chance to positively influence patients' lives while also feeling challenged, versus only 42 percent in 1990. For some reason, however, that perception didn’t translate into more students wanting to go into the field.
One possible factor, albeit one with an influence the study’s authors referred to as “complex,” could be anticipated income. “The income gap between generalist and subspecialist physicians has grown to nearly threefold,” the study’s authors write, “resulting in an income disparity of $3.5 million throughout a 40-year career.”
Ultimately, they concluded that medical schools will have to do more than improve students’ school-time experience with internal medicine in order to protect what they refer to as the “foundation of high-performing health care systems.”
Such policies include expanding scholarships and loan repayment opportunities for those choosing primary care training and practice, addressing physician work-life concerns by carefully designing patient-centered medical home models to reward visits that are not face-to-face and promote a satisfying and sustaining clinician experience, and helping primary care physicians slow the productivity treadmill by shifting away from the fee-for-service system driven by volume incentives to one driven by value incentives.
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