03/12/2013 11:37 am ET Updated May 12, 2013

A Radical Idea to Solve the Primary Care Physician Shortage

General practitioners are becoming an endangered species. By 2020, according to the Association of American Medical Colleges, the shortfall of internists will approach 100,000. That figure doesn't even consider the influx of 40 million patients expected to flood the system under Obamacare.

A recent survey of medical students found that only 2 percent were interested in becoming internists. The reasons are numerous: low pay compared to specialists, burdensome paperwork, frustrating bureaucracy, loss of clinical autonomy, and ever-declining levels of reimbursement.

Let's face facts. The genial family physician has gone the way of the rotary phone. In its place is the fast-talking FedEx pitchman, "speed treating" patients at the rate of 10 per hour. I experienced this first-hand when I went for my annual exam. As my harried internist scrawled orders for prescription refills and routine tests, we barely made eye contact. The only "exam," which consisted of listening to my heart and breath sounds, could have been conducted in the parking lot. While I don't miss shivering in the paper gown, I was surprised that I wasn't asked to remove my jacket, let alone ascend the exam table.

I don't subscribe to the theory that this state of affairs is the fault of greedy doctors. Who can blame them for finding a way to maintain their incomes so they can repay their $160,000 in student debt and earn a living after a dozen years of training? But clearly this level of care, which dumbs down doctors to a cadre of over-educated robo-signers who write scrip and send patients on their way, is unacceptable.

A solution is within easy reach. Why not eliminate this anachronistic charade of the general practitioner and use nurse practitioners and physician assistants to fill the gap? This is already happening in rural areas, which sometimes lack even a single primary care physician. Patient care would likely improve. With an average of 4-5 years of post-graduate training, nurse practitioners and physician assistants are fully capable of rendering basic patient care and making referrals to specialists as needed. Further, in patient satisfaction surveys, these health care professionals routinely outscore doctors for their patient-centered approach.

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