Though $168 million in federal funding could churn out 500 new primary care doctors over the next five years, the medical community says there is marked room for improvement.
The estimated shortage of primary care doctors could reach 21,000 by 2015, due in part to the wage gap between specialty and primary care practitioners.
When primary care program graduates emerge from medical school, it”™s not unusual to be $250,000 in debt and in need of revenue from preventative services that may go unreimbursed.
“Young physicians get hit hard because this is an expensive area to live in,” said Nancy Beran, medical director of Westchester Health Associates and an internist in Thornwood.
Generally speaking, about 50 percent of residency graduates choose to settle and practice where they”™ve been trained, according to Shantie Harkisoon, director of a new family medicine residency program at Phelps Memorial Hospital Center in Sleepy Hollow.
Though she mentioned there are a good deal of family medicine residencies nationwide, “in the last 10 years, only 27 new programs have been opened, and since 2001, there has been a dramatic increase in rates of closures of primary care and family medicine residency programs,” Harkisoon said.
Medical students have migrated toward specialty care and “even when they go into internal medicine, they still subspecialize and the same is true for pediatrics.”
Phelps”™ new family medicine residency program, which needed $2 million to $3 million to begin, was possible because of a partnership between Open Door Family Medical Centers and New York Medical College.
“So far, the health care reform bill does not aid the startup of primary care residencies, but hopefully it will help us fund the residency in the future,” Harkisoon said.
The program takes two years to start up and “all three organizations are working hard at acquiring grants and other contributions.”
Leonard Newman, president of Children”™s and Women”™s Physicians of Westchester L.L.P. and chairman of the department of pediatrics at New York Medical College, concurred that “about 25 percent to 50 percent of residency graduates (at NYMC) go into practices in Rockland and Westchester counties and throughout the Hudson Valley area.”
Newman agreed that the primary care shortage is “really profound,” especially in pediatrics.
“You can never really achieve what”™s really needed,” he said. “There are many health care assistants, nurse practitioners and physician assistants that are being trained to fill the gap, but it”™s a very difficult gap to fill. I think the need is greater than anyone anticipates.”
Newman said that his practice has developed a network of pediatric subspecialists to enhance efficiencies and simplify processes for the primary care provider.
The practice has also worked to use electronic medical records (EMR), which makes for a more seamless environment, and one that aids in recruitment of physicians that “want to work for tech-savvy practices.”
Beran said she is concerned that “all of the incentives for EMR are tied to Medicare, but as young physicians first begin in practice, they may not hit the revenue needed to achieve the Medicare incentives for EMR.”
“The legislation, more importantly, left out the bulk of pediatricians, as the only way pediatricians are eligible for EMR incentives is through Medicaid,” she said. “If you are trying to implement an EMR program for the country, why would you choose a program that does not encourage all pediatricians onto EMRs?”
Rewarding the primary care doctor is one thing, but Beran said you must dig deeper to get to underlying reasons for health care reform.
“Until a partnership exists between insurance payers, physicians and federally funded programs, a shift in medical reimbursement will be difficult to have meaning and a lasting effect,” she said.
