Before adding residency slots, Congress should demand that academic medical centers come up with a plan to improve the disorganized, fragmented care that plagues much of the country. Insurers and Medicare should pay family-practice doctors and general internists enough to keep them in the field. And federal financing for medical education programs should hinge on their plans to train more primary care doctors and fewer specialists.
Otherwise, we’ll simply end up perpetuating a system in which too many doctors provide poor-quality care at too high a price.
The authors got one sentence right.
So here is the problem. We clearly need more primary care physicians. However, even if we improve the job, we make no progress unless we are training more internists and family physicians. We do need to train more residents in those specialties AND fix the job.
We cannot wait for the latter before we address the former.
I am also tired of this rhetoric:
Increasing the number of residency slots would also mean that the United States would continue to rob other nations of their doctors. More than a quarter of American residencies are filled by graduates of foreign medical schools, more than half of them from poor countries. After training here, many stay, leaving the people of their own countries holding the bill for their training.
Most of these residents come from India and the surrounding countries. These countries have an excess of medical students. Many physicians cannot achieve success because those countries do not reward meritocracy as much as we do.
We should work on fixing the job and on increasing the pipeline. To do one without the other will just be an exercise in frustration.
{ 4 comments… read them below or add one }
Increase the number of mid-levels and amalgate FP/IM into one 4 year residency called "primary care."
I might have mentioned this here before and if so apologize for repeating myself. I have a primary care doc (internist). I think she's good – and I like her. Unless something unusual happens – my husband and I see her once a year for an old fashioned "check up". She also orders the tests she thinks we need (like I get a chest x-ray once every 2 years because I smoke). And we order our own blood work on line – very cheap – about $55 for the works. And bring the results for her to review. And that's that as long as all the tests are negative. We don't have any chronic diseases (except my husband has MS - not terrible – nothing to be done about that at his age that isn't really dangerous so we live with it).
My husband is going on Medicare next year – and we asked our family doc whether she would keep us as patients when we went on Medicare. She said yes. But she has several requirements regarding new Medicare patients – as opposed to legacy patients like us. FIrst – for her to do ok – they can only be about 25-30% of her patients. Her Medicare book is full and currently closed to new patients. Second – they have to be younger healthier people like us. She can afford to see us once or twice a year – but not once a week – at least not at Medicare rates. She can't take more than a few senior-seniors (80+) patients – the kind who go to doctors as a recreational activity and take an hour to explain what's going on with their daily bowel movements – and possibly hope to make a living. So I am not sure that more primary care by doctors who expect to make more than legal secretaries is the answer to any or all of our problems in the health care system.
Also – just as an update. My husband and I use Mayo JAX (5 minutes from our house) as a secondary and tertiary care facility (we like it a lot). I've been going through a workup recently for a problem (female stuff that may require surgery). I don't know where President Obama got the idea that Mayo is a great model for comprehensive health care – because all of my patient forms say quite specifically that Mayo does not and will not provide primary care to me once it finishes dealing with the specific condition I am getting worked up for there now. Robyn
I agree with you regarding your view on International medical graduates from India and other countries. In fact, India don't have sufficient residency position for its medical graduates. Although currently majority of them prefer to stay in U.S, but since last few years and also in future, residents will prefer to move back in their home countries especially India, due to more and more medical tourism and corporate hospitals coming up.
With due respect and being from India myself, I disagree that India has an excess of medical students and hence a surplus of doctors. Our doctor to population ratio is much worse. I do agree that a vast majority of them are not rewarded well (and when I say that, it is just not in terms of monetary compensation but also in terms of work satisfaction, infrastructure and availability of resources to practice good medicine). Although not relevant to this topic, it raises another topic of discussion.