Young doctors shifting away from private practice, primary care shortage persists

News outlets report on changes in the practice of medicine and what health reform means for primary care doctors.

The New York Times reports on a "quiet revolution" in health care: "[A]n increasing share of young physicians, burdened by medical school debts and seeking regular hours, are deciding against opening private practices. Instead, they are accepting salaries at hospitals and health systems. And a growing number of older doctors — facing rising costs and fearing they will not be able to recruit junior partners — are selling their practices and moving into salaried jobs, too. As recently as 2005, more than two-thirds of medical practices were physician-owned ... But within three years, that share dropped below 50 percent, and analysts say the slide has continued."

The larger health systems that employ doctors ideally "provide better, more coordinated care," but "there are signs that the trend toward them is actually a big factor in the rising cost of private health insurance. (Harris, 3/25).

CBS News: "With the passage of health care reform, an estimated thirty two million new patients will try to find primary care doctors. That's not going to be so easy because we already face a shortage of primary care doctors and about 13,000 more will be needed to take care of those newly eligible for insurance." The health overhaul "contains some incentives for entering into primary care," including a ten percent Medicare bonus for "doctors spending most of their time giving primary care to the elderly," but the shortage of primary care physicians is not likely to be solved in the near future, because "[i]t takes 5 to 8 years for a first year medical student to be trained as a primary care doctor" (LaPook, 3/25).

The New York Times / Chicago News Cooperative on the need for more primary-care physicians: "Just over 30 percent of doctors are in primary care — and that is trending downward — with compensation and the culture of medical schools driving students into better-paying specialties. Most people don't realize the government's role in the doctor supply. Medicare is the primary financer of postgraduate medical education, both via direct financing — subsidies to pay salaries of residents — and, indirectly, payments to hospitals for tests and other activities in which residents are involved. There has been a cap on resident slots since passage of the Balanced Budget Amendment of 1997" (Warren, 3/25).

CNN also has an article about the lack of doctors in rural areas.

Related earlier KHN story: Primary Care Shortage Could Crimp Overhaul  (Mertens, 3/22)