Primary Care Crisis

For internal medicine chief residents Matthew Costa and Joshua Latzman, a future in primary care internal medicine—is not in the cards. Their future instead: cardiology, a subspecialty of internal medicine. Take note: our medical system is based on the care of the gatekeeper physician--the primary care internal medicine doctor or family practitioner.

“Primary care physicians are really responsible for knowing the vast realm of the internal medicine field. You get to establish relationships with patients, long-term,” says Dr. Costa. Yet, that important relationship, and the entire health system as a result, is in peril. According to a new and disturbing study in the annals of internal medicine, very few want to be the gatekeeper.

The number of U.S. medical students choosing careers in primary care or family practice medicine has drastically fallen in recent years, threatening the stability of the overall health-care system. The American College of Physicians has called this an “impending crisis.” Dr. Stephan Kamholz, Chairman of the Department of Medicine at North Shore/ Long Island Jewish Medical Center, says, “The people actually choosing to go into primary care office based practice is quite small.”

The reason: it pays, relatively speaking, lousy. The annual growth in income: just one percent. “That one percent is obviously less than the growth rate of the cost of living, so even though it sounds like they got an increase, in effect it’s a functional decrease,” comments Dr. Kamholz. Fifteen percent of full time family practice doctors earned less than 100,000 dollars in 2004, while 20 percent of invasive cardiologists made more than 600,000.

“The financial burden people leave residency medical school with coupled with the salary differences determines whether someone goes into primary care or cardiology. Each year there are residents and doctors who have loans of $100,000, 200,000,” says Dr. Latzman. “I think the number of physicians entering primary care practices is not growing at the rate that would be necessary to take care of projected population needs in the next 10 to 15 to 20 years,” adds Dr. Kamholz.

 Dr. Costa says, “The notion of financial and monetary values and reimbursement always does come up and it’s never really the prime factor why someone should or does pursue a fellowship opportunity. But, that role of financial reimbursement does come into play at some point along the way.”

The authors say, specialists need to take a pay cut and pay primary care doctors more. Unless the system changes, he says primary care will literally die. And that will be a much more expensive proposition for the country, given there won’t be primary care doctors to appropriately refer patients to expensive specialty care.