California's Physician Shortage Likely to Get Worse
Health care reform law will increase demand, but low salaries are discouraging young doctors from entering primary care
Updated as of 12:18 p.m., June 6, 2011.
Retiring doctors, low Medi-Cal reimbursement rates, and the federal health care reform law are exacerbating California's shortage of primary care physicians, Bay Area health care providers and medical associations say.
Already, only a quarter of California's counties meet the recommended ratio of 60 to 80 primary care doctors for every 100,000 residents, according to the California Medical Association. (In the Bay Area, there are 78 primary care physicians for every 100,000 residents.)
“We are very much worried about the shortage in general,” said Callie Langton, health care workforce policy expert at the California Academy of Family Physicians. “Twenty years ago, a lot more physicians were going into primary care, and the replacement rate is not high.”
Nearly a third of doctors are 60 or older and are close to retirement, but only 42 percent of medical students are going into primary care. According to the California Medical Association and the California Healthcare Foundation, the number of young doctors pursuing primary care decreased over the past decade because the it's one of the lowest paid medical specialties.
Family practitioners earn an average of $143,000, while anesthesiologists and surgeons can earn well over $200,000, according to the Bureau of Labor Statistics.
"Payment is a big concern," said Langton. "Primary care physicians have lot of debt. They earn a respectable salary, but coming out of medical school with as much debt as you’ll earn in a year, some students are encouraged to choose sub-specialties so they can pay off debt faster. So, we have a shortage of primary care physicians because of that."
Eighty percent of medical school graduates begin their careers in debt; on average, doctors graduating from public medicals school leave owing $150,000, while those graduating from private medical schools have, on average, $177,500 in debt, according to the Association of American Medical Colleges.
While the number of primary care doctors is shrinking, the demand for the care they provide is about to soar, thanks to the federal health care reform law.
Under the law, known as the Affordable Care Act, as many as 6 million more Californians will be able to obtain health insurance coverage, with nearly half eligible for coverage under Medi-Cal. Many of the newly insured will try to seek treatment from primary care physicians and family practice doctors, who provide the kind of cradle-to-grave, coordinated care that emphasizes preventive medicine, which can help reduce health care costs.
But fewer physicians than ever — just 57 percent — say they are now willing to accept new Medi-Cal patients, according to the California Healthcare Foundation. Many doctors say the reimbursement rate — that is, the amount of money the state pays them for treating patients — is too low. California sets the rate, which is the fourth lowest among all 50 states, according to the California Medical Association.
voltairesmistress
Thank you for this article.
Market forces have long discouraged medical students from deciding to work as primary care doctors. The greatest incentive, beyond the reward of the work itself, would be greater compensation, particularly in underserved areas of the state. Is there a way for Medicare and private insurers to raise compensation for primary care/preventive medicine while lowering compensation for highly compensated specialties?
So far, the Bay Area has attracted plenty of primary care physicians, but which California counties are suffering from a shortage of primary care doctors?
A follow-up story that addressed these issues would be really interesting.
Margaret Kirkham
In Ms. Fuentes' article, "California's Physician Shortage Likely to Get Worse," she points out that there are not going to be enough family practice physicians to take care of California's growing population. Ms. Fuentes fails to mention that even though there are a fair number of physicians rejecting family practice, there is a significant and growing group of nurse practitioners and physicians assistants who are more than willing to work in the family practice setting. We are bridging the gap and thus filling in for those physicians who are seeking financial rewards in specialty settings. We are paid even less than physicians and work just has hard to provide the same or even better care for our patients. We nurse practitioners and physicians assistants are the wave of the future and patients will be seeing more of us for their daily ills.