Series Overview: Primary Care Under Pressure

Many health experts are predicting a major shortage of primary caregivers in the near future.

A major reason is the graying of the massive baby boom generation: By 2030, 70 million Americans — 1 of every 5 — will be over age 65. And seniors need and use more medical care.

The new health law will also add to the demand for one-on-one care. By 2019, an estimated 32 million more Americans will have health insurance than have it now.

And for many patients, the shortage is already a reality.

Sixty-five million Americans live in areas designated by the federal government as having a shortage of health professionals. And a 2008 survey found that more than a fifth of Medicare patients and nearly a third of patients with private insurance reported an unwanted delay in getting an appointment for routine care.

Yet fewer medical students than ever are choosing primary care as their profession. Of the 24,000 medical students who entered residency programs this year, according to the New England Journal of Medicine, between 16 and 18 percent are likely to end up practicing primary care, which includes general internal medicine, pediatrics and family medicine.

Money is obviously a big reason medical students opt to become specialists rather than generalists. According to the 2010 survey by the Medical Group Management Association, the median primary care doctor salary in 2009 was $191,401. The median dermatologist's salary was $385,088, while the median salary for a cardiologist was $457,310.

For students graduating with medical school debt often in the six figures, that's not an insignificant difference.

But there are other reasons medical students shy away from primary care.

"When you survey medical students when they enter medical school, a very high percentage are interested in primary care," says Alain Montegut, vice president for primary care development at Martin's Point Health Care in Maine. "Then they lose that interest over that four years because they're not exposed to it. They don't have the role models, and the payment system is geared toward specialty care."

There is also the perception that primary care doctors work longer hours and have less job satisfaction than other types of doctors.

Health-policy makers are now trying to address all of those factors in efforts to "reinvent" primary care around the nation.

The new health law boosts payments for primary care — not just for doctors, but also for nurses and physician assistants who are also key primary caregivers, particularly in rural areas. It also expands programs that help repay student loans for health professionals who agree to practice in areas with shortages of health personnel.

Many states and health organizations are also experimenting with new ways to organize primary care practices. One that is gaining popularity is known as the "patient-centered medical home." The idea is to have health care providers — doctors, nurses and even social workers or nutritionists — work in teams to give patients a single place to get most of their medical needs tended to and coordinated. The idea is to take some of the pressure off overworked doctors and make care more efficient, cheaper and more pleasant for the patients.

This series will examine some of the pressures on the primary care system — and some of the potential solutions.

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