Publisher's Synopsis
As a result of a number of factors including compensation, practice environments, and experience in medical school, there is a shortage in the number of primary care physicians that is accelerating. In addition, a percentage of obstetricians/gynecologists serve as primary care providers, particularly among their younger female adult patients. While there are real shortages in general surgery and key pediatric and internal medicine subspecialties, the shortage in primary care providers, particularly those capable of caring for adults with chronic disease, overshadows the deficits in all other specialties. This shortage is especially critical in the context of health care reform objectives that have the potential of adding 32 million newly insured individuals that will only further increase the need for primary care physicians. The current U.S. primary care physician workforce is in jeopardy of accelerated decline because of decreased production and accelerated attrition. A review of questionnaires administered to all 2008 allopathic and osteopathic medical school graduates revealed that only 17 percent chose any of the primary care specialties as their first choice. This decreased medical student interest in primary care is caused by multiple factors including the high workload and insufficient reimbursement of this field of practice relative to the earnings of many specialists. These factors, in addition to the "hidden curriculum" in many medical schools that actively discourages student interest in the adult primary care specialties, the lack of strong primary care role models, and dynamic practice environments in other specialties often absent onerous administrative requirements, contribute to the reluctance to enter primary care disciplines. This workforce is also in jeopardy because of the substantial reduction in the production of primary care physicians from graduate medical education. Expansion of subspecialty training options, loss of primary care training positions (especially in family medicine), and alternate career options (such as general internal medicine graduates choosing to work as hospitalists) have effectively reduced primary care production by one-third over the last decade. Additive is the overall aging of the current primary care workforce and its anticipated retirement, particularly should the economy continue to improve. There is one essential caveat that should be addressed. While this report's emphasis is on the overall need for primary care physicians, it must be clearly stated that this reflects the need to increase the numbers of physicians capable of caring for adults and their associated chronic disease burden. This does not appear to be the case for general pediatrics. In fact, student interest remains high and has led to a surplus, relative to other areas of primary care, in the supply of general pediatricians. During the last decade, there have been increases in the numbers of medical students who are choosing general pediatrics. With regard to the supply of general pediatricians and in the context of this report, the major challenge is their geographic maldistribution. The Council on Graduate Medical Education met in April and November 2009 and April 2010 to review the current environment and develop recommendations. The Council identified four challenges and developed five recommendations as presented in this report. The challenges are: 1) The practice environment, 2) The environment in medical schools, 3) The graduate medical education environment, 4) The geographic maldistribution of physicians in practice. Recommendations to address these challenges are presented in five categories: 1) The number of primary care physicians, 2) Mechanisms of physician payment and practice transformation for primary care, 3) The premedical and medical school environment, 4) The graduate medical education environment, 5) The geographic and socioeconomic maldistribution of physicians
