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Illumination magazine.
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New & Now: Fall 2008

Darkness Visible

Trains on Time

Vision Quest

Plastic War

Disappearing Doctors

Bad Business

Early Warning

Protective Paste

 

Disappearing Doctors

As patients grow older, the number of generalist physcians declines.

For more than 40 years, health care administrators and patient advocates have been concerned about widespread shortages of primary care physicians. A new study led by MU's Jack Colwill, professor emeritus of family and community medicine at MU and a member of the National Academy of Sciences' Institute of Medicine, indicates this troubling trend is accelerating.

"During the past decade, the number of generalist graduates in family medicine, general internal medicine and general pediatrics has fallen by 22 percent, and declines continue as medical school graduates enter other specialties," Colwill says. "At the same time, the U.S. population is increasing by about one percent each year, and the population is aging."

These numbers don't bode well, especially for older Americans. On average, Colwill and his co-authors found, elderly patients visit general practitioners or internists three times each year -- double the rate of adults younger than 65.

As more and more baby boomers grow old, the overall number of doctor visits is expected to rise by an estimated 29 percent. The number of general internists and family physicians, meanwhile, will likely increase by less than 5 percent. If these projections prove accurate, the U.S. would require an increase of 44,000 family physicians and general internists in less than 20 years to maintain current levels of service.

Money is one reason for the looming shortfall, the study found. Doctors with specialties tend to bring in considerably more income than family physicians and general internists who provide primary care. Quality-of-life issues are another. Specialists take few emergency calls, while internists find themselves responding to patient needs at all hours.

Projected shortages could compound disincentives for medical school graduates to practice primary care, as well as raise quality-of-care concerns, says Colwill. "As patient numbers rise, these practitioners will be doing more urgent care and will have less time for preventive services, coordinating care with other specialists, and getting to the depth of their patients' problems. This will increase the load on other, already overloaded specialists and lead to even more referrals and increased costs of care."

The solution, Colwill argues, starts with "making primary care practice more manageable and income comparable with that in other specialties." Health providers might also embrace new models of primary care such as "medical homes," facilities where teams of physicians, nurse practitioners, physician assistants and others provide comprehensive primary care services while collaborating to manage patients with chronic illnesses.

"Student interest in primary care careers can be enhanced if medical schools renew their commitment to the education of primary care physicians," says Colwill. "Incentives such as forgiveness of loans for primary care practice would also tip the scales for many medical students and residents as they select a specialty and type of practice."

The study, Will Generalist Physician Supply Meet Demands of an Increasing and Aging Population? was written by Colwill and co-researchers James Cultice from the U.S. Health Resources and Services Administration and Robin Kruse, a research assistant professor at MU.

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Published by the Office of Research.

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