Physician shortage projected Specialists in U.S. have edge on primary-care practitioners.

Abraham Mahshie

Jun. 21, 2008 (McClatchy-Tribune Regional News delivered by Newstex) -- A nationwide trend for medical students to pass up working as primary-care physicians and work in more lucrative specialties could mean a shortage of 44,000 family physicians by 2025.

That finding, recently published in the policy journal Health Affairs, was co-written by Jack Colwill, professor emeritus of family and community medicine at the University of Missouri.

"The biggest dilemma will be that when people want to see their primary-care doctor, getting an appointment is going to be a lot harder," Colwill said, adding that the change would put pressure on specialists to provide general medicine needs. "Largely, it probably relates to following the dollars."

Colwill and his research team of Robin Kruse, professor in family and community medicine, and James Cultice of the U.S. Health Resources and Services Administration used data from the National Ambulatory Medical Care Survey to find that a 22 percent drop in generalist graduates in the past decade combined with the aging baby boomer generation will contribute to the gap.

Colwill called for states and medical schools to increase loan forgiveness programs and put greater emphasis on rural-practice and primary-care programs.

Harold Williams, chairman of family and community medicine at MU, said medical schools are doing their job, but it's not breaking the wave of students entering specialty areas.

"Ironically, I think primary care in general and family medicine in particular have been much more successful in medical schools as academic departments," he said. "It's just that the student interest isn't there." Medicare "reimbursements for some specialties -- dermatology, radiology, anesthesiology -- is very high for the amount of time that people spend actually doing it."

Tim Reid, a resident physician at University Hospital, said the prospect of a higher salary and more free time persuaded many of his classmates to specialize in an area of medicine.

"Obviously, if you can make more money by not working as hard that's nice, and all the time with family plays into that," Reid said. "I'm not trying to say that people going into specialties are lazy, but if you told me you could work 30 hours and earn $250,000 a year and the average primary-care doctor works a minimum of 50 hours and earns $140,000," primary care "is hard to sell people."

Reid is an exception to the national trend. As a senior in high school, he signed an agreement with the rural hospital in his town, committing to return and work after medical school. Carroll County Memorial Hospital will pay some $20,000 yearly toward Reid's undergraduate and graduate loans for every year he works at the hospital.

For Reid, returning to Carrollton was what he was planning to do, anyway.

"I grew up in a small town, and that was the type of doctor that I knew that was my doctor growing up," he said. "Before medical school, I hadn't had a whole lot of exposure to specialists."

A fellow resident physician, Tim Mayfield, had a different experience. As a sophomore in college, he returned to home in Cape Girardeau and worked with Orthopedic Associates there. The exposure to surgery solidified his commitment to general surgery.

"At Mizzou, we're kind of geared toward cranking out more primary-care folks for Missouri," he said, but with more and more students entering medical school already committed to a specialty, it might be too late to appeal to them. Of his classmates, Mayfield said, "there are a lot of driving forces. ... There were people who kind of chased the money, and people who chased lifestyle, but a lot of people felt most comfortable after trying a certain type of field.

"In my class, I feel like nobody tried to pigeonhole themselves into a field of medicine just because it was going to pay them the most," he added.

"This is really caused by modern-day medicine," said 74-year-old physician Curtis Long, who has operated his private practice from the same building in Butler for more than 40 years.

Long and his wife, Ann, were recognized yesterday by the medical school for making an undisclosed donation to fund a resident fellowship. The school renamed the Department of Family and Community Medicine in their honor.

Long said he wants his gift to address the void in rural communities.

He said specialists receive much higher insurance reimbursements than primary-care doctors, causing a pay difference. "If they would reimburse the family practitioner, then you would see more want to go into it," he said, "... but the modern-day specialization has plucked them off."

or amahshie@tribmail.com.

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