Primary Care Physician Shortage

[Bnol143]

With a trend of Family Practice Physicians shortages, I am wondering what everyone thinks might be a good incentive to attract Physicians back to this area of medicine? I know PAs are supposed to help address this shortage, but without supervising physicians we are unable to fulfill this deficit.

 

Are incentives such as promising shorter hours and increased salary viable options? And if so, will the added responsibilities and cons of this area fall upon PAs driving down their job satisfaction? I would love to hear some thoughts and input.

[rcdavis]

Unless stopped, Obama care will address this by influencing the number of residencies available, and the reimbursement.

Eventually Obama care will morph into its philosophic root program, Hillary care, and physicians will Be directed to what they can do, in what areas, for how much.

 

If stopped, the simple laws of supply and demand will apply. Unless impeded by restrictive government reimbursement rates, as hospital and regional centers need more "feeder" providers, they will will have to pay more to get them in the face of scarcity.

 

Eventually making FP an attractive choice.

 

Another option will ge to have MLP satellite centers, overseen by Medical center, not on site, physicians..l each physician responsible for 5-10 MLPs,.again.. Feeding the regional center.

 

Just my thoughts, as paranoid as they are.

[Gordon, PA-C]

Primary care shortage is a MYTH. The only shortage is in places where nobody wants to go (i.e. rural places with towns no bigger than 5k population).

[SHU-CH]

Loan repayment programs (NHSC, some state programs) are a pretty attractive incentive given the debt load that health profession graduates incur. If a student is interested in primary care I always recommend they look into it.

[winterallsummer]

More reliable loan repayment options and better salary. Many of us want to go into primary care but because of such a huge debt will be choosing to pursue more lucrative careers. The loan repayment programs are nice but ultimately not reliable and a bit of a financial risk (eg get the job for months and takes months for the application ONCE the cycle begins, then not knowing if you will get accepted or not, and if something happens at the job and you have to leave losing the money etc).

 

I actually would like to go into FP and wouldn't mind rural, but when I graduate here in a year-ish I will be pursuing something more lucrative because I have a huge stack of debt to pay back.

[ventana]

honestly, I don't believe we need that many physician primary care providers. What we need is an army of PAs and NPs.

 

certainly a physician holds a higher level of knowledge, but for 99% of the patients an established versatile educated, PA can handle it. I would think the move towards more collaboration agreements, allowing PAs direct bill, allowing PAs to own one hundred percent of the company, getting reimbursed the same as physicians (the cost of running a primary care clinic is the same for overhead rather, it is PA or M.D.)

 

in Massachusetts. There is no maximum number for the number of PAs which a physician may supervise, seriously one dock could supervise 10 PAs, and have a primary care empire. This way they could preserve a very high income by making a little bit of money, not a lot, off each PA.

 

 

The other issue is postgraduate residency training. We really should have a one year or possibly 18 month residency training for outpatient primary care. This would allow us to advance equivocal to the DNP movement.

 

All this is just my opinion, thoughts?

[Gordon, PA-C]

honestly, I don't believe we need that many physician primary care providers. What we need is an army of PAs and NPs.

 

certainly a physician holds a higher level of knowledge, but for 99% of the patients an established versatile educated, PA can handle it. I would think the move towards more collaboration agreements, allowing PAs direct bill, allowing PAs to own one hundred percent of the company, getting reimbursed the same as physicians (the cost of running a primary care clinic is the same for overhead rather, it is PA or M.D.)

 

in Massachusetts. There is no maximum number for the number of PAs which a physician may supervise, seriously one dock could supervise 10 PAs, and have a primary care empire. This way they could preserve a very high income by making a little bit of money, not a lot, off each PA.

 

 

The other issue is postgraduate residency training. We really should have a one year or possibly 18 month residency training for outpatient primary care. This would allow us to advance equivocal to the DNP movement.

 

All this is just my opinion, thoughts?

 

 

Why would PAs choose primary care? That makes zero sense. You can graduate PA school right now and make DOUBLE in a subspecialty compared to primary care, with ZERO extra training. I dont understand why any PA would choose to take a 100% pay cut to practice primary care.

 

In the future, with all the specialty CAQ crap coming down the pipeline, it wont be easy to switch between specialties. I recommend all graduating PAs to go into a subspecialty.

 

Also, are you sure about Massachusetts? I found a website that says the PA limit is 4 per physician.

 

http://www.mass.gov/eohhs/gov/departments/dph/programs/hcq/dhpl/physician-assistants/scope-of-practice/supervising-physician.html#supervise

 

How many physician assistants can a registered physician supervise?

The statute ( MGL, c. 112, s. 9E) specifies that a physician shall supervise no more than four physician assistants at any one time.

[rev ronin]

You can graduate PA school right now and make DOUBLE in a subspecialty compared to primary care, with ZERO extra training. I dont understand why any PA would choose to take a 100% pay cut to practice primary care.

 

You're being hyperbolic here, and it doesn't help your case. I got an excellent primary care job right out of school, and I have seen NO PA job offering anywhere listed for more than 150% of what I'm making, not even in surgical subspecialties in high-cost locales. I will buy a 33% pay cut to work in primary care... but even still that seems like pushing it, because the jobs are not apples-to-apples comparisons. I can work when my supervising doc is out of the country, and take off when he's around, and no one really cares, because in family medicine the roles are much more interchangeable than surgery.

[physasst]

Here's a study I published a year or so ago....

 

http://journals.lww.com/jaapa/Fulltext/2012/07000/A_descriptive_analysis_of_factors_influencing.12.aspx

 

It's more complicated than just money. Interestingly, and this has been found in physician studies too, there is a negative impression of primary care. They simply don't think it is enjoyable or a good career path, regardless of income.

 

Income is a factor...but it is far from the only one....

 

As far as PC shortages being a myth, well, that's BS. Although you are right that the shortages are not in suburban areas, With 2.7 trillion dollars in annual health spending, America has no excuse for decreased access to basic health services. About 45% of physicians are packed into 1% of the land area with 10% of the population while 65% of the nation’s population lives in 40,000 urban and rural zip codes or 2800 metro or non-metro counties associated with lower to lowest health care workforce. Overall, there is still a PC shortage.

[Boatswain2PA]

Why would PAs choose primary care? That makes zero sense. You can graduate PA school right now and make DOUBLE in a subspecialty compared to primary care, with ZERO extra training. I dont understand why any PA would choose to take a 100% pay cut to practice primary care.

http://www.mass.gov/eohhs/gov/departments/dph/programs/hcq/dhpl/physician-assistants/scope-of-practice/supervising-physician.html#supervise[/url

 

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A 100% pay cut? Might want to review that statistics class you took. Are you sure you think you are equal to a PGY5-6? BTW...the only residencies I know if that are 5-6 yes is Neuro and Plastics (not counting fellowships).

[KMD16]

Specializing as a PA is a waste of knowledge. The surgeon takes the glory while you slave for them. I make more now in UC + PT FP than I made in neurosurgery. There's a lot of money to be made in FP if you're exp PA.

[Guest Paula]

honestly, I don't believe we need that many physician primary care providers. What we need is an army of PAs and NPs.

 

certainly a physician holds a higher level of knowledge, but for 99% of the patients an established versatile educated, PA can handle it. I would think the move towards more collaboration agreements, allowing PAs direct bill, allowing PAs to own one hundred percent of the company, getting reimbursed the same as physicians (the cost of running a primary care clinic is the same for overhead rather, it is PA or M.D.)

 

in Massachusetts. There is no maximum number for the number of PAs which a physician may supervise, seriously one dock could supervise 10 PAs, and have a primary care empire. This way they could preserve a very high income by making a little bit of money, not a lot, off each PA.

 

 

The other issue is postgraduate residency training. We really should have a one year or possibly 18 month residency training for outpatient primary care. This would allow us to advance equivocal to the DNP movement.

 

All this is just my opinion, thoughts?

 

I agree. AN extra year of post-graduate training (or tacked on as part of PA training in primary care) is needed for us to keep up with the NPs in states that have full autonomy (full practice authority). Especially those who attain the DNP and stay in clinical practice. I just finished my Masters completion program and compared my curricula to a DNP. Guess what? It was very similar. Except mine was masters and theirs was DNP.

 

PAs in primary care who decide to work in rural, underserved, urban medicaid population and the places docs won't go should be allowed to have full practice authority, and develop collaborative agreement with the local hospitals or specialists they send patients to. No more of this "dependent and supervised" practices. Those restrictions need to go.

 

I work rural, make over 100K and am on salary. Those jobs are out there if you look for them and hold the line for expecting a good salary. Maybe I was just lucky?

[Gordon, PA-C]

A 100% pay cut? Might want to review that statistics class you took. Are you sure you think you are equal to a PGY5-6? BTW...the only residencies I know if that are 5-6 yes is Neuro and Plastics (not counting fellowships).

 

In my area the surgical PAs average about 140-170k (depending on experience), the primary care PAs make about 70-90k (depending on experience). You do the math.

 

I've worked at several institutions, and you are damn straight I am better than every PGY 5-6 I have encountered. I work in pediatric surgery, which is PGY-5 for general surgery and PGY6-7 for pediatric surgery fellowship. I've had over 15 attendings tell me directly that I'm better than any pediatric surgery fellow (PGY 6-7) and they want ME on their cases, not the green fellows.

 

Guess who decides which cases the residents and fellows get to scrub on? I DO. When there's a difficult case, I bump the peds surgery fellow out of the way and I do the vast majority of the case.

 

So to summarize, not only am I equal to those PGY6-7s, I'm BETTER than they are. My attendings know this too.

[rcdavis]

 

Guess who decides which cases the residents and fellows get to scrub on? I DO. When there's a difficult case, I bump the peds surgery fellow out of the way and I do the vast majority of the case.

 

How does this help the fellow or resident get the training he NEEDS To become a competent attending. I appreciate how well you do your job, but as a training institution .. Shouldn't the difficult cases be Exactly those in which the trainees scrub? Just askin...

[ventana]

Why would PAs choose primary care? That makes zero sense. You can graduate PA school right now and make DOUBLE in a subspecialty compared to primary care, with ZERO extra training. I dont understand why any PA would choose to take a 100% pay cut to practice primary care.

 

Wow - that is some bad math there - how did you make it though school? 100% pay cut is a salary of ZERO per year

 

As you age and gain more understanding of life and your own happiness I hope that you realize that pay is not the only way to happiness. I love Primary Care and make a decent living at it. Sure I can make more in speciality medicine, but for me that is not it. I have worked inpatient, per diem for ortho, ER, Occu health, Chronic Pain, and per diem jobs in other specialties as well. But CHOOSE internal medicine because it is where I 'fit'. honestly I think it is one of the hardest fields to do well as you have a HUGE amount of knowledge to try to learn unlike ortho or pain or just about any speciality where you only are responsible for your own speciality. It is not about the money, it is about being happy.

In the future, with all the specialty CAQ crap coming down the pipeline, it wont be easy to switch between specialties. I recommend all graduating PAs to go into a subspecialty.

With this logic there would not be any PCP's (PA, NP, MD, DO) out there at all - might work for you to chase the almighty dollar, but others (me) want to do things that I love to do.

 

Also, are you sure about Massachusetts? I found a website that says the PA limit is 4 per physician(you seem to have all the answers yet not the correct facts. See below)

 

http://www.mass.gov/eohhs/gov/departments/dph/programs/hcq/dhpl/physician-assistants/scope-of-practice/supervising-physician.html#supervise

 

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Yes, mass has unlimited number of PAs per doc - passed last summer

also we have to be recognized by all insurance companies

We no longer have to have our SP name on script

We can own 99% of a corp

We can write Schedule II-V but have to have to "notify" our SP of Sch II with in 96 hours (I just send and email)

Overall MASS is really friendly!

 

 

 

Overall, very scary that a PA would feel this close minded about medicine and the primary care fields. I am hoping this is an aberration and not a new normal for the PAs we are producing today....

 

On a side note, for the first time ever I had a family member tell me that their cousin was going to PA school so they could become a Doctor some day - stepping stone for a traditional student.... bad bad..

 

 

As for you local sample size for primary care versus specialty pay, I think that your evidence is under powered at best, and outright wrong at worst. You always 'hear' about the out layers - Oh the PA in Neurosurg made $170k last year (course he worked 3800 hours!) and the other end is the PCP who is complaining that they only get $75k....

 

I have seen and suspect I will see more and more PCP PAs getting pretty decent pay - not as high as the specialties, but certainly over 100k with a great work schedule. This is due to the fact there is a shortage of PCP's doc's and the trained experienced PA truly can do 99% of what a doc does in the office setting.... the large companies and employers are realizing this and at the same time have to compete with the specialties as it is easy to switch.....