Wanted: General Practitioners. NOW!

by Bradley Miller on April 29, 2010

How do we get more high quality med students to become GPs and internists (and not give internal medince the ol' one finger salute?)I’ve got a job for you!  How does this sound – spend your college days studying away (sorry, only minimal time for parties) worrying about standardized tests, spend 7-8 years after college training for your job, go in the financial hole on average $160,000 and for the first 4 years of your career earn $45,000.  Sound good?  There’s more.

Spend the rest of your career jamming in as many clients as possible a day – maybe upwards of 20 or so – worry about malpractice insurance, be squeezed by Medicare. And, while earning a respectable salary, there’s really no hope of raises outside of adjustments for inflation.  In fact, there’s a high probability outsiders will likely attack your salary and maybe even reduce it.  Did I mention about mountains of paperwork and clients wanting your professional opinion for free?

Sounds a bit dramatic, but that’s the negative side – aka the con side –  that a person faces when deciding whether or not to be a General Practitioner.  I was sparked to write this post when a friend of mine – Ab Brody, PhD, NPtweeted about a new Journal of the American Medical Association (JAMA) article laying out some of the challenges in recruiting MDs to General Practice.  The current healthcare reform debate has renewed the debate over the types of MDs we need to train.

Indeed, there are lots of benefits to being a GP – not the least of which is the satisfaction of getting to know families, helping people overcome day-to-day medical issues, etc.  It’s truly rewarding.  But compared to other professions and medical specialties I have no idea of why, from a financial perspective or even a career fulfillment perspective why anyone would choose General Practice.

Dermatologists – same professional satisfaction.  Sure, you have to look at the occasional butt pimple, but you can make a dramatic difference in someone’s life.  Career satisfaction?  Check!  Good hours? Check!  Oh, and on average they make $351,000 annually.  Or, 2.5 times what a GP makes.

I’ve done the math – a GP, making the average salary and with the average student loan debt load will never be able to purchase a house in San Francisco without significant additional income.  If that same physician buys a modest house in Atlanta, by the time they’re 65 they’ll have almost $500k in the bank.  However, that’s much less than what other careers bring in. It’s more than a lot of people, but given the struggles they went through to become physicians, it’s not all that much.

To be sure, I’m writing this post to be incendiary and provocative.  I truly believe that GPs will be the heart of healthcare reform here in this country and I hope we start treating them like so.  Why?  Because we need them – they coordinate care, they’re the first line and if trained the right way they can be beacons of savings – to the tune of several billions of dollars of savings each year.  But, we need to fix the factors that I spend time lampooning above.

How do we get more smart, young physicians to become GPs?

So how can we rectify this issue? I think that the first step is to come clean and admit that it’s, at least a little bit, about the money.  There’s absolutely nothing wrong with wanting to earn a great living.  If someone offered you a better lifestyle, more pay, better hours, wouldn’t you take it?  We need to change how we reward our GPs – base their income on outcomes.  Patient outcomes, that is.  Promote tort reform to help avoid frivolous law suits.  Provide scholarship opportunities to help them with the financial hole they face out of school.  And, to boot, pay them commensurate with other areas of medicine.  We’ll all benefit from that!

The demands we place on GPs are too great – the malpractice threats, the paperwork, diminishing incomes/reimbursements, etc.  It’s a tremendous burden even outside the financial disparities.  Add both of those to the pot and it’s a surprise anyone becomes a GP.

It’s also a reputation issue, too. Or at least that’s the way I’d argue it.  My medical school, for one, highly praised those who went to specialty residencies.  Let me be clear – I’m exceptionally proud of all my classmates and their choices.  However, the school did a super lousy job pointing students to general med.  I’d even say that it was actively passively dismissed though the school’s emphasis on specialties and choosing a competitive specialty as the highest success.  In fact, we really didn’t have a fantastic role model to emulate in the GP space – compared to access to the best heart surgeons, cancer docs, orthopods, etc in the world.  IMHO.  I’d say a lot of med schools actively dissuade the pursuit of becoming a GP through how the schools grade, praise specialties, elevate their leaders, etc.  Becoming a GP was passively aggressively looked down upon.

Lots has to happen between now and then – I’m really curious to hear your thoughts.  Should GPs be paid better salaries? What role should they play in our healthcare system?

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