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Time To Think Seriously About PCPs (Or the Lack of Them)

October 27, 2008
by Mark Hagland
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As if hospitals and the healthcare system didn’t already have enough concerns ahead, a study published last month in the Journal of the American Medical Association revealed that only two percent of graduating medical students plan to work in primary care in internal medicine, a backbone of the primary care-based healthcare system. Among nearly 1,200 fourth-year medical students that JAMA surveyed, only two percent say they’ll go into internal medicine, a steep plunge from the nine percent who had made such plans as fourth-year students back in 1990.
Why so few? Some medical students cite paperwork and the challenges of dealing with chronically ill patients. "I didn't want to fight the insurance companies," Dr. Jason Shipman, 36, a radiology resident at VanderbiltUniversityMedicalCenter in Nashville, Tenn., who is carrying $150,000 in student debt, told the Washington Post.
But more than the chronic care issue, a fundamental reason is the salary gap, and the fact that many medical students these days simply can’t see any way of paying off their medical school loans long before retirement on the $186,000 average internist pay, when orthopedic surgeons, for example, earn an average of $436,000.

There are clear clinician workflow, staffing, and efficiency issues here. Hospitals and health systems depend heavily on internists (and at academic medical centers, which generally do not have family practitioners, internists really are the core primary care attendings), and if so few medical students who are graduating soon are going into internal medicine, the healthcare system will have to find new ways to become more efficient and to handle such shortages over the long term.

It seems obvious to me that, while automation can never completely solve such profound staffing problems, IT will be called on as never before to address what looks to become a very long-term situation. All clinicians—primary care physicians, physician assistants, specialists, nurses, pharmacists, techs, and the like—will have to learn to work more efficiently and to optimize the previous resource of time even better than they can do so now. And as a result, clinical documentation, clinical decision support, medication ordering, electronic medication administration, PACS, and other clinical information systems, will all need to be optimized as fully as possible.

And CIOs, in concert with clinician leaders and with other members of the c-suites in their organizations, will need to look at clinician staffing more intensely than ever before, in order to prepare for coming shortages across numerous medical specialties. There really isn’t an alternative, if the patient care delivery system as we know it is to continue to function.

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