MU researcher calls for incentives to increase numbers of primary care practitioners
Mo.- By 2025, the wait to see a doctor could get a lot longer if the
current number of students training to be primary care physicians
doesn't increase soon, according to a new University of Missouri study.
Jack Colwill, professor emeritus of family and community medicine in
the MU School of Medicine, and his research team found that the U.S.
could face a shortage of up to 44,000 family physicians and general
internists in less than 20 years, due to a skewed compensation system
that rewards specialists increasingly more than primary care
practitioners. The researchers are more optimistic about the future
supply of general pediatricians.
Today, generalist physicians
are a third of the U.S. physician workforce and are responsible for
more than half of all patient visits at doctors' offices.
about the supply of generalists is not new," said Colwill, who also is
a member of the National Academy of Sciences Institute of Medicine. "It
has been with us since the 1960s and was gradually improving. However,
during the past decade, the number of generalist graduates has fallen
by 22 percent and declines continue as medical school graduates enter
other specialties. At the same time, the U.S. population is increasing
by about one percent each year, and the baby boomer generation will
significantly increase the number of Americans older than 65 by 2025.
the study, which was published in a recent edition of Health Affairs,
Colwill and co-researchers, James Cultice from the U.S. Health
Resources and Services Administration and Robin Kruse from the
University of Missouri, used data from the National Ambulatory Medical
Care Survey to estimate the future demand for generalist care. The
Census Bureau predicts that the number of adults will increase 21
percent by 2025, and the number of Americans older than 65 will rise by
Typically, older adults seek care from
generalists nearly three times each year, double the rate of adults
younger than 65. Because of this, Colwill and his researchers expect
the number of doctor visits to increase by 29 percent by 2025. At the
same time, they project that the supply of general internists and
family physicians will increase less than 5 percent.
patient numbers rise, these practitioners will be doing more 'urgent
care' and will have less time for preventive services, coordinating
care with other specialists, and getting to the depth of their
patients' problems," Colwill said. "This will increase the load on
other, already overloaded specialists and lead to even more referrals
and increased costs of care. We need to change the incentives by making
primary care practice more manageable and income comparable with that
in other specialties."
Colwill strongly endorsed development
of new models of primary care called "medical homes" where teams of
physicians, nurse practitioners, physician assistants and others
provide comprehensive primary care services that also focus on
management of patients with chronic illnesses. These models promote
more access through expanded hours and use of telephone, e-mail and
electronic medical records. If appropriately reimbursed, these models
should increase quality, reduce overall costs and improve both patient
and physician satisfaction.
"At the same time, numbers of
graduates must be increased," Colwill said. "Students' interest in
generalist careers can be enhanced if medical schools renew their
commitment to the education of generalists as they have done earlier.
Further, incentives such as forgiveness of loans for primary care
practice would tip the scales for many medical students and residents
as they select a specialty and type of practice."
Association of American Medical Colleges recommends that medical
schools increase their enrollment by 30 percent, but have not indicated
specific specialty areas for the increase. Colwill said this enrollment
increase could result in more specialists, but little increase in
primary care physicians if the incentive for becoming generalists is
not examined soon.