What Medical Students Should Know About the US Primary Care Physician Shortage

The Washington Post reported that despite attempts to raise awareness about the need for more primary care physicians (PCP) in the US, medical school graduates are becoming increasingly less likely to go that route. Not only that, but the 2019 National Resident Matching Program (“the Match”) offered a record-high number of PCP positions, including internal medicine, family medicine, and pediatrics, to this year’s graduating class, only to have a record-low number of positions filled.

Cleveland.com highlighted not only the shortage, but also its potential impact on patients: fewer doctors, mean fewer choices. Patients might struggle to get appointments and be forced to seek out care in more expensive emergency rooms. This, in turn, could lead to the widening of health disparities between the wealthy and the underserved. Cleveland.com further revealed Ohio alone is headed for a shortage of 1,200 PCPs by 2025.

WPTA21.com featured an article on why it takes so long to get a doctor’s appointment. The answer was a simple one: not enough PCPs. And with 31 percent of PCPs over the age of 60, the problem will only get worse as they retire. “I see up to 15 patients a week. It’s a strain on the system,” said family physician and Indiana State Medical Association president Lisa Hatcher.

CalMatter sought to get to the heart of California’s physician shortage, citing the case of 71-year-old physician Daniel “Doc” Dahle, who cannot retire because there’s not a replacement for him. It identifies high student loan debt and the desire to go into higher-paying specialty fields; low Medi-Cal reimbursement rates which impact doctors most in low-income areas and in primary care; a preference among physicians for practicing in urban areas new more facilities; and a lack of diversity. UC Davis Medical School Dean of Admissions and Outreach, Mark Henderson, said, “We still don’t take enough students from (rural and underserved) communities that will have a deep desire to want to go back to the community. You have to take a different type of a student, you can’t take the same old usual suspect.”

Salon also looked at the problem of why fewer medical students are choosing to go into primary care, landing on money as a major factor. Match CEO Mona Signer said, “I think part of it has to do with income. Primary care specialties are not the highest paying.” Signer also pointed out that medical schools are typically part of larger medical centers which prioritize research and specialization. As such, PCP specializations can be overlooked and devalued.

Making the problem even worse, according to a MarketWatch piece, is the fact that as more female doctors move to work part-time or stop working completely, patient care can suffer given that treatment by female doctors has been linked with better patient outcomes, according to Harvard Health Publishing.

AAMCNews reported on a 30 percent spike in medical school enrollments, which may ultimately help with the physician shortage, including in primary care. However, the article also calls for an increase in the number of residencies and clerkship training sites in order to keep up with the number of medical school graduates.

The state of California, meanwhile, is taking innovative new measures to recruit physicians who pledge to spend approximately a third of their time with low-income patients: paying off their medical school debt. According to a report from Fortune.com, the program is intended to counter the shortage of healthcare professionals in the state, although its success may be compromised by the fact that today’s medical school graduates have their pick of jobs.

A letter to the editor published in The Washington Post presents a hopeful solution to the PCP dearth: admitting more diverse students. “We’ve found that admitting diverse students and teaching in an environment focused on social service and community engagement help guide our graduates’ medical journey. Our schools have an average 91 percent residency attainment rate for first-time-eligible 2018-2019 graduates, so our students can select among all types of residencies and locations. Yet, many choose to go where they’re needed most,” wrote medical school deans Heidi Chumley and William F. Owen, Jr.

On a related note, a piece published on the Center for American Progress suggests hiring more immigrant doctors may be the solution to PCP shortages in rural areas. Recruiting and retaining immigrant doctors can only be accomplished, however, with changes to visa policies which reduce the barriers to licensing and practice.

Vox further suggested foreign doctors could also play a critical role in reducing physician burnout, another factor that exacerbates PCP shortages. The piece shares the story of Kristina Sokolovska Konieczny, who attended medical school and practiced primary care medicine in her native country of Macedonia (now North Macedonia), but works as a nurse in the US because of the time and money it would take to get certified to practice. “Why are we letting talent go to waste?” the article asks.

Medical News Today took the same position, citing a report published in HealthAffairsBlog. “Rural and underserved communities in the United States have long struggled to attract high-quality physicians in sufficient quantities. Incentive programs have attempted to bridge this gap, but shortages remain. Our analysis suggests that physicians entering from these countries [...] are situated on the front lines of medical need,” the report states. Medical News Today goes on to put forth yet another complication: the “hostile environment” in the US due to ongoing anti-immigrant rhetoric.

Several sources, including US News & World Report and Cleveland.com, point to the important role nurse practitioners could play -- and in some cases already do play -- in bridging the gap between patients and primary care.

And the problem is not contained to the US. Articles in the East Anglian Daily Times, The Eyre Peninsula Tribune, and The Mainichi pointed to doctor shortages in the UK, Australia, and Japan, respectively.

According to an editorial published in The Press-Enterprise, the solution to the doctor shortage is as much about supporting the institutions that train them as it is about supporting the doctors themselves. “The greatest indicator of where physicians will practice is where they completed their medical training. So as the state of California admirably embraces measures to address the physician shortage, its leaders must not overlook an obvious part of the solution – train more doctors in underserved areas,” it proposes.

A BBC article sharing the story of of Yousef El Tawil’s difficult journey to medical school backs up the assertion put forth by The Press-Enterprise. After growing up in a poor neighborhood in London, struggling in school, and failing to achieve good enough A-levels to get into medical school, he persevered and gained entrance. His goal? To eventually practice in the area where he grew up. “It’s still my community, my people and I’m proud of it,” El Tawil declared.

But the solution may not be entirely human. Undark says that AI may become increasingly important -- not as a replacement for human physicians but as a collaborative partner. “AI systems could free overworked doctors and reduce the risk of medical errors that may kill tens of thousands, if not hundreds of thousands, of US patients each year. And in many countries with national physician shortages, such as China where overcrowded urban hospitals’ outpatient departments may see up to 10,000 people per day, such technologies don’t need perfect accuracy to prove helpful,” it proposes.

A Forbes piece suggests while technology may indeed play a role in the physician shortage, there may be another solution beyond changing reimbursement, work-life balance, and amping up investment in prevention. “90% of Americans live within 15 miles of a Walmart. Can any hospital system or university health center say that? If [Walmart] wanted to, they could break the industry over their knee.” The idea of the third-largest retail pharmacy creating its own medical school or hospital isn’t so farfetched,” asserts Publicis Health Media’s chief connected health officer Brendan Gallagher.

One last thing to keep in mind about the shortage? While the situation may seem dire, the attention focused on the issue offers hope for a solution...