By Andrew Villegas
For decades, just about everybody who has looked at the supply of primary care doctors in this country has warned of trouble ahead.
But despite the urgency of report after report, including another recent one from the the Josiah Macy Jr. Foundation, the primary care physician workforce of the future looks like it will lag behind the need.
Medical students generally prefer the bigger paychecks and greater prestige of specialties.
"There's been 50 years of turning away from primary care in this country," said George Thibault, president of the Macy Foundation, in a recent conference call announcing the foundation's findings, which say, among other things, that medical schools should create primary care tracks for educating students.
Some evergreen recommendations call for paying primary care doctors more and, recently, using primary care offices a medical homes to coordinate all of a patient's care to manage costs and care.
The doctors shortage is looking more problematic as the nation faces an influx of patients after insurance coverage is extended through the new health overhaul law, said Ann O'Malley, with the Center for Studying Health System Change. "Time will tell" whether that will make a difference, O'Malley said. "I don't know how bad things have to get before the support required is given to primary care."
The notion that decades of blind eyes turned toward the warnings prompted us to dust off a few highlights from days gone by. Here goes:
- The Journal of the American Medical Association called for more primary care all the way back in 1933 when an editorial recorded "the overgrowth of specialism, now so bitterly complained of, and the fadeout of the general practitioner."
- Fast forward to a 1961 JAMA paper, in which one researcher said, "There is a shortage of general practitioners, family doctors, generalists, call them what you may. This is true in our urban as well as our rural areas. It is true throughout this great country of ours. I do not mean that there is a shortage of physicians, but there is a need for physicians who are interested in the total and continuing care of the patient."
- Two decades later and the calls to action included a proposal from Republican Sen. Dan Quayle, in 1985, for states to meet quotas for primary care residencies.
- In 1992, just before President Clinton's attempt at health overhaul, the Council on Graduate Medical Education released a report in 1992 that found: "The Nation has too few generalists and too many specialists." The group again called for more primary care doctors in a 1994 report that called on officials to steer at least 50 percent of graduating doctors to primary care.
- In 2008, The Physicians' Foundation released a report that physicians themselves -- 78 percent of those surveyed -- said they thought there was an existing shortage of primary care doctors.
Villegas is a reporter at Kaiser Health News, a nonprofit news service.