Friday, November 20, 2009

How to Solve the Primary Care Shortage

With health care reform promising to insure forty million more people, there is already hand wringing about who will see all these new patients. As anybody who has been to a doctor's office knows, the wait can be interminable. There is such a shortage of primary care doctors in this country that drastic measures have been suggested, including increasing the salaries of primary care physicians, lowering the salaries of specialists, or offering free medical education to any medical student willing to go into primary care for a certain number of years.

There is one way to increase the number of available primary care doctors in this country but one dares not speak of it in polite company. I will show you studies, from the AMA even, to prove my hypothesis. The solution to providing more primary care doctors is so simple, yet so politically incorrect. Are you ready? Here it goes. The solution to finding more primary care doctors is to stop admitting women into medical school. What?! Gasp! How dare you! That is the most piggish thing I've ever heard!

Okay, chill. I never said the solution was going to be practical or even feasible. Some of my best friends are female physicians, terrific doctors they are. But I also know many female doctors who have slowed down their practice to go on the mommy track. Or they decided they just weren't feeling well enough to work that day and could somebody please cover for them since coincidentally they are supposed to be on call that day. Or they just have to get out by 4:00 PM to make their Pilates class.

Let me show you the statistics to prove that having more male physicians will lead to more patients being seen with not too much effort. The statistics come from the federal government's own agency, the U.S. Dept. of Health and Human Services. They published a report called The Physician Workforce: Projections and Research into Current Issues Affecting Supply and Demand. There is a separate page devoted to female physicians. Most of the data cite the AMA as the source.

The report says that in 2005 nearly half of medical students are female. They may be more than half by now. Female doctors tend to go into the primary care fields and OB/GYN. Whereas only 4% of orthopedic surgeons and 14% of general surgeons are female, 52% of general pediatricians and 31% of internists are women. Female doctors are attracted to fields with flexible working hours and office based settings. Their salaries tend to be lower too, with average female physicians making $149,000 per year while male physicians make on average $206,000. Even when adjusted for specialties and work experience, men make $38,000 more than women.

But women work less than men. Female doctors work an average of 49 hours per week while male doctors work 57 hours a week. Women also tend to work fewer weeks each year. Female physicians take longer to see each patient, on average 2 minutes longer than men. So if you have an office of 30 patients, that is 60 minutes of extra time that women need to see all of them. Therefore increasing the number of female doctors has not alleviated the primary care shortage that one would expect.

The problem with female physicians being less productive is not isolated to this country. In this (chauvinistic) blog from the United Kingdom, the author notes a study that says 60% of female doctors drop their practices after ten years. He questions the value of government money that is used teaching so many female medical students who eventually waste their medical knowledge. Would that money have been put to better use to teach male medical students who will go on to a lifetime of productive medical caring and teaching? Who is hurt when so many well trained doctors drop out of the work force? It is the patients who suddenly lose their primary doctor when she announces she is "retiring" at the age of 36 to start a family. It is the patient who now has insurance but can't find a doctor to take care of her or has to wait two months for the next appointment. When you have 40 million more people show up at your doorstep, how high do you think the primary care doctor burnout rate will get?

By having more male doctors, productivity goes up. More patients are able to get an appointment. All that government money used to teach medical students will be placed with doctors who have longer medical careers thus amortizing the cost of the education. With longer careers, there is greater knowledge and experience, hopefully preventing simple medical errors common with all new doctors. Let's see, more male doctors equals more patients seen each day, with more hours worked each week and more years of productive work and fewer medical complications. Sounds like an easy solution to the primary care physician shortage. Logical? Yes. Doable? Hell no. We are never going back to the 1950's again in regards to workplace inequality. But this goes to show that the answer could be so simple, with the government's and the AMA's own studies to back it up. Now we have to do the hard thing: find more money to increase the number of medical school graduates and pay primary care physicians higher reimbursements so more will choose that field. And don't forget to let them out early so they can make their core strengthening program.

1 comment:

  1. For those of us female physicians - and I am an anesthesiologist no less, of which there are fewer than there are female surgeons - I worked up until my due date when the university made me take maternal leave, I have worked non-stop the past 11 years after having my child. During that 11 years, I took one day off after an emergency orthopedic surgery. I taught more than 750 residents as the former chief of obstetric anesthesia at the University of Miami (largest residency program in the US)and never missed a day. I've been in private practice since 2004 and put in twice as much time and effort as male colleagues - many of whom were/are younger and who care more about their tennis matches, hair appointments, going the gym, etc. I've also noted they've had more law suits because they don't spend an extra 2 minutes to find out the important things about a patient. The problem rather is we are raising a nation of sniveling children who don't think it's reasonable to work for a living - it includes both sexes. One of the reasons I left academics was the lower quality of medical students/residents - people who had a shift-mentality. I've also known male colleagues who have quit or gone part time to fulfill some inner-child BS. My feeling is that they need to have a better handle on who is coming into the profession seriously to take care of patients - rather than people who simply want a fat, reliable paycheck. As chief of anesthesia at a critical access hospital, I work a full case load - about 60-65 hours a week, take a full call load like everyone else,plus do the administrative work. Women who are more concerned about having a family than being a doctor shouldn't go into medicine - true - but men who's idea of being a doctor is to be very full-of-themselves but not be adequate shouldn't go into it either.