Shortage of Family Physicians Troubles States, ERs

"This spring, 385 students graduated from Georgia's medical schools, but only two of them chose to remain in the state to pursue a family medicine residency," the Atlanta Journal-Constitution reports. "Overall, 20 students, or 5 percent, chose to go into family medicine —- half the number that it was just five years ago." More than one-third of counties in Georgia, "many of them rural, are officially designated as primary-care health professional shortage areas," meaning there is "less than 1 doctor for 3,500 people." According to a recent study from the University of Missouri School of Medicine, "there could be a nationwide shortage of around 44,000 primary-care doctors by the year 2025, due to an aging population and fewer doctors training in primary care."

One issue contributing to the problem in Georgia is that "70 percent of all [medical school] graduates leave the state for their residencies," and those students tend to "establish medical practices in the communities where they complete their residencies." Another problem is that "Georgia's newly minted doctors, like their colleagues across the country, are deciding less and less that primary care is right for them." Instead, many go into specialties—"the most popular non-primary care specialties this year in Georgia were orthopedic surgery (7 percent) and anesthesiology (6 percent)." According to the American Academy of Family Physicians, foreign students are stepping in to fill the gap—"international graduates have stepped in to take almost half (40%)" of family medicine residencies (Lee, 7/20). 

The shortage of primary care physicians is also contributing to overcrowding in emergency departments nationwide, Time reports. "The overcrowding in EDs is so bad these days that patients who walk in with 'immediate' needs, meaning the most severe on a clinical scale, wait an average of 28 minutes to see a doctor, according to a Government Accountability Office report released in May. That's 27 minutes more than the recommended wait time for such conditions. Between 1996 and 2006, even as some 200 EDs shut down completely, visits nationwide went from 90 million to 119 million, according to the Centers for Disease Control. Emergency departments are so packed that an ambulance is turned away and sent to one farther away every minute. " 

The uninsured are "not the major reason EDs are becoming standing room only." Instead, Time reports, the real problems are: "insured patients who come to the ED because they can't get in to see or don't have a primary care physician; very sick patients who end up being "boarded" in EDs for days because of a shortage of open hospital beds; and a fee-for-service health care system that encourages hospitals to invest not in EDs, which are often money losers, but on high-margin procedures like elective in-patient surgery." After Massachusetts mandated health insurance for all, the EDs got even more crowded. "Visits to already over-crowded EDs jumped 7% in two years and ED costs increased 17%, according to data obtained by the Boston Globe. In other words, if any health reform package expands insurance to cover some or all of the nearly 50 million Americans without it now, EDs are likely to be one of the first places to feel the impact." With Obama considering cuts to Medicaid and Medicare funding for hospitals, the impact "could be even tougher than expected" (Pickert, 6/19).

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