More than money is needed to increase the primary care workforce

April 5, 2009

The Danbury News-Times
Linda Tuccio Koonz, Letters Editor

Ellen Goodman in her April 5 article “The Care in Health Care” comments on the scarcity of primary care doctors and suggests that students shy away from careers in primary care because compared to doctors who for example, perform surgery or do stress tests or CAT scans, primary care doctors are paid much less.

She’s right but paying primary care doctors more will not attract enough of them to make a difference. Ironically, as pointed out by Dr. Thomas H. Lee in the Dec.18, 2008 issue of the New England Journal of Medicine, when payments to primary care doctors were increased, they actually saw fewer patients! Paying primary care doctors more is long overdue but, any increases will quickly disappear by paying for and maintaining new computer equipment for electronic medical records and hiring more office personnel.

The move to get more students into primary care has to start in the medical schools and their admissions process. For decades the trend of medical education has been towards specialization. Some of the advantages of this approach include improved ways of treating diabetes and serious infections, life-saving cardiac bypass surgery, hip and knee replacements that lessen disability, eye surgery that prevents blindness and many new surgical techniques that improve patients’ lives.

But medical schools have neglected primary care. They, as much as the health insurers are responsible for its decline. By favoring students whose aptitudes suited them for a career in a specialty it was only natural that primary care dwindled.

One way to solve the primary care shortage would be for colleges and medical schools to design special primary care programs that turn out more primary care doctors quicker. If done right such programs could produce competent primary care doctors. It is one way of solving the shortage.

Ed Volpintesta MD