The best hospitals can be the worst--when it comes to PCPs

Sometimes, the "top hospitals" ranked by magazines and websites are actually the worst when it comes to providing what Americans really need--trained primary care physicians.

This issue begs the question, as reported by the Atlantic, "What does it mean to be [newly] able to afford care if no one is there to provide it?"

The Atlantic outlines how Philip Longman, demographer and research fellow for the New America Foundation, looks at the distribution of federal dollars on physician training.

As Longman points out in the current issue of Washington Monthly, the 759 institutions in the U.S. with residencies receive an estimated $13 billion federal dollars every year. However, 158 of those institutions produce zero graduates that plan on going into primary care. And the worst offenders, in terms of the number of primary-care physicians produced, are the hospitals "we hold in highest regard," which include: Mass General, New York Presbyterian, Cleveland Clinic, Brigham and Women's, Stanford and Washington University in Saint Louis.

Longman's slightly blithering description of what goes on at The Johns Hopkins Hospital in Baltimore paints a picture of this issue:

"…Its teaching hospital in Baltimore towers over a low-income neighborhood designated by the federal government to be suffering from a shortage of primary care doctors. Yet between 2006 and 2008, of the 1,148 residents who graduated from Hopkins's residency programs, only 8.97 percent went into primary care," Longman writes. "Only two graduates went on to practice in a federally qualified public health clinic, and not one participated in the National Health Service Corps, a program designed to encourage doctors to practice in underserved areas. In 2009, Hopkins residency programs costs the taxpayers $80.7 million."

After profiling a "typical overworked, underpaid primary care physician" in Scranton, Pa., Longman suggests that Congress demand that [residency]-sponsoring institutions "increase their production of primary care doctors and of other health care professionals of the kinds we need, or risk losing their subsidies."

In related problems, a commentary in the New England Journal of Medicine noted that a residency shortage is leaving new physicians with no place to train.The NEJM said that with medical classes projected to reach 21,434 students by the 2016-2017 school year, nearly a 30 percent increase since 2002, there is not enough  residency posts to accommodate all the medical graduates.

As FiercePracticeManagement previously reported, 2013 marked the fourth straight year in which the residency-matching program placed increased numbers of medical school graduates into primary care training positions--due to increased competition in specialties and the Affordable Care Act's heavy emphasis on primary care.

In March, Reps. Allyson Schwartz (D-Pa.) and Aaron Shock (R-Ill.) reintroduced a bill to create 15,000 more residencies over the next five years--at a cost of $1 billion per year. 

To  learn more:
- read the article in The Atlantic
- read the report in Washington Monthly