The ratio of primary care physicians to specialists is disconcertingly "out of kilter," Daniel Burke, M.D., of the University of Colorado Family Medicine Residency, said at a press briefing on Friday.
At the event, hosted by the Colorado Commission on Family Medicine in the District of Columbia, a panel discussed the primary care physician (PCP) shortage, its relationship with graduate medical education (GME) and the challenges of recruiting rural PCPs.
Hospitals that received GME payments determine which residencies they sponsor, and more than 20 percent of teaching hospitals do not produce any PCPs, Burke said. "Aggressive, deliberate policymaking" will be necessary to correct the imbalance, he added.
Tom Told, interim dean and chair of rural medicine at Rocky Vista University, described his experiences as a PCP in rural Colorado and the challenges of recruiting medical students to work in rural settings.
"Everybody that comes to my school says they want to be a rural family physician in a small town" whether that's true or not, he said. "We ... are trying to come up with the profile of someone who would be more successful to go into rural programs or go into primary care. I think community-to-school incentives, state incentives … will pay off, [but] it's a slow process to get there."
Ted Epperly, M.D., CEO of Family Medicine Residency of Idaho, discussed the PCP shortage in the context of a recent report from the Commonwealth Fund, which found that the United States ranks first in healthcare costs but last in care quality.
The current healthcare system is one of "haves and have-nots" and had "played the wrong team on the field," Epperly said.
Two things will drive meaningful change in terms of care quality and outcomes, Epperly said: increased coverage and making sure Americans have a usual, reliable source of care.
"Medicine is the only sector in the American economy where as we increase technology, we increase costs," he added.
Epperly further called for doctors to "evolve their thinking" on team-based care, which he said begins at the medical school level. "Doctors are kind of like cats," he said. "We don't work very well together."
A recent report found that, for the second consecutive year, more students graduated from medical school than there were available residencies, FierceHealthcare previously reported.
To learn more:
- read the GME Initiative's 2013 GME reform proposal (.pdf)