Rebuilding Primary Care Workforce
The MPCC "Primary Care is in Crisis" white paper series (2009) defines the crisis and identifies contributing factors. Resolution of the crisis requires efforts in three arenas:1) transformation of the way primary care is delivered and compensated, 2) activation of healthcare consumers and 3) rebuilding the primary care workforce. Part 4 of the series provides information on the declining workforce and recommendations for stabilizing and rebuilding the Michigan workforce.
White Paper Series: Primary Care is in Crisis
Part 4: Rebuild the Primary Care Workforce
A Declining Workforce
"In 2009, for the 12th straight year, the number of graduating U.S. medical students choosing primary care residencies reached dismally low levels. Overloaded primary care practices, whose doctors are aptly compared to hamsters on a treadmill, struggle to provide prompt access and high-quality care. Three major factors contribute to this crisis.
1. Primary care physicians earn far lower incomes than procedural specialists, reducing career attractiveness for medical students with high debt burdens.
2. The work-related stresses felt by primary care physicians tags primary care as the career with more work at less pay.
3. Medical education favors training in non–primary care fields. Rescuing primary care requires national policies that address all three issues."
(Thomas Bodenheimer, Kevin Grumbach, and Robert A. Berenson, “A Lifeline for Primary Care,” The New England Journal of Medicine 360(26)(2009): 2693-2696.)
Similar trends are occurring among nurse practitioners and physician assistants. Even with implementation of team care models, there are insufficient numbers of nurse practitioner and physician assistant graduates to take up the slack.
Michigan is facing a serious shortage/maldistribution of doctors, nurse pratitioners and physician assistants.
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Public policy interventions are needed to correct anticipated primary care workforce shortages as well as the current maldistribution of that workforce in Michigan. Timely action is urgent because the Michigan economy makes it particularly difficult to recruit and retain primary care providers.
Workforce Trends
click here for additional slides on the declining workforce
Challenges of Primary Care Practice
Primary care doctors are forced to see a high number of patients in order to make ends meet. An increaing number of those patients have one or more chronic illnesses that need more time. Doctors are increasingly burdened by administrative requirements and paperwork that compete with time to provide care. They lack the time and resources to equip their practices with electronic tools and processes that could facilitate the provision of preventive care and care for individuals with chronic illnesses. _ % of primary care physicians surveyed in --- indicated they plan to retire or seek a different occupation within 5 years.
Unattractive Career Choice
Many students entering medical school plan to become primary care doctors. However, by the time they graduate, most have weighed the benefits of specializing in primary care versus other specialties and they ultimately choose the latter. Obvious benefits, in addition to salaries of specialists averaging two to four times that of generalists, are that specialists typically work fewer hours and have a more controlled life style.
Resources and Links
The Michigan Health Workforce Center click here
- 2009 Physician Licensure Survey click here
- 2009 Survey of Michigan Nurses click here
- 2009 Physician Assistant Licensure Survey click here
- 2010 A Profile of Michigan's Nurse Practitioner & Physician Assistant Workforce click here
Blue Ribbon Report: Physician Supply and Demand Through 2020 (summary) click here
Dr Grumbach Feb.2, 2011 presentation to MPCC on Assuring an Adquate Primary Care Workforce... click here