Monday, April 07, 2008

Shortages: Not Just for Nurses Anymore

Doctors are leaving primary care in droves. That's the word on the street. Even my own doctor is leaving our local health center to become a hospitalist. As malpractice insurance goes through the roof, paperwork requirements become more stringent, and reimbursement rates plummet (even for Medicare and Medicaid claims), it seems that more and more doctors are choosing to specialize, leaving the pedestrian boredom of primary care for the sexy remunerative opportunities of various medical specialties.

Now, I'm sure that the reasons for a primary physician shortage are far more nuanced than I have so flippantly elucidated here, but the sad reality is that millions of Baby Boomers will begin to retire any day now, and they will all be in need of long-term primary care and preventive medicine in order to keep them healthy and out of the hospital.

In this market-based system, it seems that generalist doctors are being forced to specialize as a way of coping with increasing costs and decreasing revenues. In medical schools, interns and residents apparently are also learning how financially unrewarding primary care can be, and when one considers the cost of attending medical school in the first place, it is no wonder that newly-minted doctors want to maximize their earning potential right out of the gate.

Some reports indicate that advance practice nurses (such as nurse practitioners) will begin to fulfill more and more primary care duties as the shortage of primary care doctors grows, and talk of a new Doctor of Nursing Practice doctoral degree may lead to even more nurses assuming a roles historically held by doctors. These moves may help to assuage the crisis, and all options should be on the table as the crisis deepens.

As for me, I will return to the care of a Nurse Practitioner who left our little health center a few years ago for another position and has now returned. I love the care I receive from a nurse practitioner, and see no reason why I should see a doctor when my NP is capable, competent, and clinically skilled. Sure, my doctor is leaving and I wish him well, but for me there's no crisis, just an opportunity for change.

For the country as a whole, a physician shortage is most certainly problematic, and a shortage of primary care physicians could be devastating. Couple this with an ongoing nursing shortage, and you have one big healthcare mess on the plate of the next president who takes office in nine months.

So, the docs fly the coop and we're left holding the primary care bag. Just how to resolve such a crisis remains to be seen, and it is all of us who will pay the price when the proverbial healthcare feces hits the fan.
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