Massachusetts: More Primary Care Physicians Needed

Even before the state began mandating on July 1 that virtually all residents have health insurance, patients were having trouble getting to see primary care physicians. That problem will likely worsen now that thousands of newly insured residents will be seeking regular care, not just emergency room attention for their ills and injuries. Public and private sector officials should be planning now to ensure that the state's corps of primary care physicians expands with the need.

At the heart of the shortage is the difference between typical reimbursements for primary care doctors and specialists. The former can expect to earn $160,000 a year, according to national data, while obstetrician/ gynecologists earn an average $230,000 and dermatologists $300,000. Such a gap in earning potential looms large to young doctors completing medical school with $100,000 to $200,000 in debt. The lure of a specialist's income is especially strong in a place like Massachusetts, where the price of housing greatly exceeds the national average. At least partly as a result of this financial squeeze, interest in general internal medicine has waned. As recently as 1998 it was the choice of 55 percent going into the profession, while in 2005 just 20 percent chose it.

Suggested Remedies:

• look at the workload in physicians' offices to see if responsibilities could be more effectively distributed. For the treatment of diabetics, for example, a dietitian could be part of a team of caregivers that would free up the internist to tackle other duties.

• Consider a loan forgiveness programs in which young doctors who agree to work in primary care in underserved areas are compensated for tuition debt left over from medical school.

The Massachusetts health reform law has set the state on a bold course to provide insurance coverage to nearly all its residents. But that achievement will be hollow if there are not enough front-line doctors to meet the need. The state and healthcare providers must look to all possible measures, including an even bigger loan forgiveness program if that's what it takes, to ensure that coverage really means care. source: The Boston Globe