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hAS THE DEMAND FOR PRIMARY-CARE PHYSICIANS PEAKED?
Primary-care physicians have been the darlings of managed care for the past couple of years. But, to paraphrase a hit song from yesteryear, "Will they still love you tomorrow?" The answer: Maybe.
A lot depends on where you're located. If you're a family practice resident in Chicago or a solo internist in Atlanta who seeks to join a group, your phone may still be ringing off the hook — for now. But your counterparts in Los Angeles and New York are seeing the demand for their services plummet. Those markets are glutted. Other urban areas will follow.
Yet a 1996 survey report from the Council on Graduate Medical Education predicted a shortage of 48,000 generalist physicians by the year 2000, falling to 39,000 a decade later. While this would suggest continued feast rather than incipient famine, consider the following:
Nationwide openings for primary-care physicians have already declined. Our company is the largest physician-recruitment firm in the U.S. Forty percent of the positions we're trying to fill nationwide are for primary-care physicians. That's good for you. However, we also conduct an annual Recruitment Practices Survey that tracks physician job opportunities from year to year. Openings for primary-care physicians have declined as much as 18 percent. That's not a good sign.
Some places have too many doctors. If you head for the less-populated, more rural parts of America where the physician-patient ratio remains low — states like Alabama, Arkansas, Idaho, Mississippi, South Dakota or Wyoming — you're apt to find intriguing opportunities well into the next century. But if you have your heart set on Boston, Los Angeles, New York, San Diego, San Francisco, Philadelphia, Seattle, or Washington, D.C., be prepared to take what you can get — if, that is, you can even find a job. Such places are drowning in primary-care physicians, competition is fierce, and the situation isn't likely to improve.
The demand for primary-care physicians may be overstated. Estimating future demand is always a tricky business. Let's say that three competing hospital systems in a given region separately determine that the area requires 200 more primary-care physicians. Each then sets out to hire, acquire, or affiliate with the doctors needed to make up the shortfall. Within a year or two, each system now has its 200 additional primary-care physicians in place. The problem is that they've collectively added 600 doctors, not the 200 that the area required. That's how yesterday's drought can become tomorrow's flood.
MCOs are starting to say, "You can be replaced." You may work with nurse practitioners and physician assistants and consider them a blessing. Cost-conscious managed-care organizations are taking your point. Increasingly, they're saying, "Why pay three primary-care physicians $135,000 a piece to do what one physician and two midlevel providers can accomplish, particularly since the latter cost only half as much?"
Not only can these skilled professionals perform routine care, but they're often more willing than physicians to move to undeserved areas. But physicians may change their tune about these locations when, unable to find the employment they want in popular urban areas, they begin to look elsewhere — only to find physician extenders already entrenched.
Your star status as a gatekeeper may not last. Some managed-care plans are having second thoughts about the role of primary-care physicians as gatekeepers. Patients are clamoring for open access to specialists, and some HMOs in California, Minnesota, and elsewhere are starting to offer it, finding it more efficient and no more expensive than the gatekeeper model. MCOs nationwide are watching these experiments like hawks. If open access catches on, the demand for your services as a managed-care provider may be drastically reduced.
Specialists are becoming competitors, too. The ascendancy of primary-care physicians under managed care has hit subspecialists where it hurts: in the wallet. As a result, some are officially retraining as generalists; more are quietly expanding into primary care. Look for increased competition from this quarter in the days to come.
So that's the dire scenario. But every argument has two sides. Let's play devil's advocate for a moment. Consider the following:
Statistics never tell the whole story. Not everyone who graduates from medical school today is a potential competitor. More than one-fifth of U.S. physicians are in training, academia, administration, or research. While two-fifths of current medical-school graduates are women, and female physicians tend to gravitate to primary care, they also tend to work fewer hours and see fewer patients per hour than their male counterparts. In their case, increasing supply doesn't necessarily correlate with decreasing demand.
An aging population will boost demand. Moreover, patient demand for primary care is on the rise. According to the Census Bureau, Americans age 65 and over will increase by more than 5.5 million between 1996 and 2010. In contrast to the general population, they'll generate about twice the rate of office visits to doctors, almost three times the rate of diagnostic, therapeutic, and surgical procedures, and nearly three times the rate of discharges from short-stay hospitals, says the National Center for Health Statistics.
This being the case, the demand for primary-care physicians is apt to remain strong for some time to come, provided you don't insist on the bright lights of Broadway, the glitter of Hollywood, or the stately marble monuments of Washington as your backdrop. But look at it this way: Best-selling novelist John Grisham lives in Mississippi, the President of the United States calls Arkansas home, and Idaho and Wyoming boast some of the most exquisite scenery to be found in America. You could do worse.
This article was published by Cejka Search and originally appeared in Medical Economics Magazine. Copyright by Medical Economics Company Inc. at Montvale, NJ 07645. All rights reserved.