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.
The author, David E. Williams, is the co-founder of MedPharma Partners who writes regularly on the Health Business Blog.
I agree that the Caribbean Medical Schools will be key in solving the doctor shortage. I will attending one of these schools, UMHS St. Kitts, this fall. It's exciting that I will be able to achieve my dream of becoming a doctor. I also agree that, in addition to higher medical school admissions, greater residencies will be key in solving this issue.
Everybody is commenting that US grads are not joining in the primary care residencies. That is partially correct. But where are the remaining unfilled positions? . look at match results for the last 10 years there are no unfilled primary care positions available . Those positions were filled by IMGS and US IMGS( Caribbean medical graduates). So practically there are no unfilled positions. look at the current 2011 match . There are still 12000 graduates ,who did not get any residency position. The truth is THERE ARE NO SUFFICIENT NUMBER OF PRIMARY CARE RESIDENCY POSITIONS ARE AVAILABLE IN USA. By increasing the medical school admissions nothing will happen. Number of residency positions should be increased. with out increasing residency positions and by increasing us medical school admissions , we will produce same number of doctors. IMGS will be gradually eliminated from the match.
Residency and interniship are already paid for by the government so the only debt that they accrue happens during the four years of medical school. The high debt load is the result of going to private vs public medical schools. if we stopped paying the full cost to train as many specialists and shifted those funds to repay the medical school portion of primary care doctors you would see a shift over-night. Family practice only has about 45% of its slots filled by graduates of US medical schools (one of the lowest rates) so it is disingenuous to stay that there has been a significant growth in the number of doctors choosing primary care.