Tag: primary care

U.S. Medical Students Less Likely To Choose Primary Care Path

The primary care physician shortage has long been predicted, and as less and less American med students choose that path, it is sure to become a reality.

By Victoria Knight

Despite hospital systems and health officials calling out the need for more primary care doctors, graduates of U.S. medical schools are becoming less likely to choose to specialize in one of those fields.

A record-high number of primary care positions was offered in the 2019 National Resident Matching Program — known to doctors as “the Match.” It determines where a medical student will study in their chosen specialty after graduation. But this year, the percentage of primary care positions filled by fourth-year medical students was the lowest on record.

“I think part of it has to do with income,” said Mona Signer, the CEO of the Match. “Primary care specialties are not the highest paying.” She suggested that where a student gets a degree also influences the choice. “Many medical schools are part of academic medical centers where research and specialization is a priority,” she said.

The three key primary care fields are internal medicine, family medicine and pediatrics. According to the 2019 Match report, 8,116 internal medicine positions were offered, the highest number on record and the most positions offered within any specialty, but only 41.5% were filled by seniors pursuing their M.D.s from U.S. medical schools. Similar trends were seen this year in family medicine and pediatrics.

In their final year of medical school, students apply and interview for residency programs in their chosen specialty. The Match, a nonprofit group, then assigns them a residency program based on how the applicant and the program ranked each other.

Since 2011, the percentage of U.S.-trained allopathic, or M.D., physicians who have matched into primary care positions has been on the decline, according to an analysis of historical Match data by Kaiser Health News.

But, over the same period, the percentage of U.S.-trained osteopathic and foreign-trained physicians matching into primary care roles has increased. 2019 marks the first year in which the percentage of osteopathic and foreign-trained doctors surpassed the percentage of U.S. trained medical doctors matching into primary care positions.

Medical colleges granting M.D. degrees graduate nearly three-quarters of U.S. students moving on to become doctors. The rest graduate from osteopathic schools, granting D.O. degrees. The five medical schools with the highest percentage of graduates who chose primary care are all osteopathic institutions, according to the latest U.S. News & World Report survey.

Beyond the standard medical curriculum, osteopathic students receive training in manipulative medicine, a hands-on technique focused on muscles and joints that can be used to diagnose and treat conditions. They are licensed by states and work side by side with M.D.s in physician practices and health systems.

Although the osteopathic graduates have been able to join the main residency match or go through a separate osteopathic match through this year, in 2020 the two matches will be combined.

Physicians who are trained at foreign medical schools, including both U.S. and non-U.S. citizens, also take unfilled primary care residency positions. In the 2019 match, 68.9% of foreign-trained physicians went into internal medicine, family medicine and pediatrics.

But, despite osteopathic graduates and foreign-trained medical doctors taking up these primary care spots, a looming primary care physician shortage is still expected.

The Association of American Medical Colleges predicts a shortage of between 21,100 and 55,200 primary care physicians by 2032. More doctors will be needed in the coming years to care for aging baby boomers, many of whom have multiple chronic conditions. The obesity rate is also increasing, which portends more people with chronic health problems.

Studies have shown that states with a higher ratio of primary care physicians have better health and lower rates of mortality. Patients who regularly see a primary care physician also have lower health costs than those without one.

But choosing a specialty other than primary care often means a higher paycheck.

According to a recently published survey of physicians conducted by Medscape, internal medicine doctors’ salaries average $243,000 annually. That’s a little over half of what the highest earners, orthopedic physicians, make with an average annual salary of $482,000. Family medicine and pediatrics earn even less than internal medicine, at $231,000 and $225,000 per year, respectively.

Dr. Eric Hsieh, the internal medicine residency program director at the University of Southern California’s Keck School of Medicine, said another deterrent is the amount of time primary care doctors spend filling out patients’ electronic medical records.

“I don’t think people realize how involved electronic medical records are,” said Hsieh. “You have to synthesize everything and coordinate all of the care. And something that I see with the residents in our program is that the time spent on electronic medical records rather than caring for patients frustrates them.”

The Medscape survey confirms this. Internists appear to be more burdened with paperwork than other specialties, and 80% of internists report spending 10 or more hours a week on administrative tasks.

The result: Only 62% of internal medicine doctors said they would choose to go into their specialty again — the lowest percentage on record for all physician specialties surveyed.

Elsa Pearson, a health policy analyst at Boston University, said one way to keep and attract primary care doctors might be to shift some tasks to health care providers who aren’t doctors, such as nurse practitioners or physician assistants.

“The primary care that they provide compared to a physician is just as effective,” said Pearson. They wouldn’t replace physicians but could help lift the burden and free up doctors for more complicated care issues.

Pearson said more medical scribes, individuals who take notes for doctors while they are seeing patients, could also help to ease the doctors’ burden of electronic health record documentation.

Another solution is spreading the word about the loan forgiveness programs available to those who choose to pursue primary care, usually in an underserved area of the country, said Dr. Tyree Winters, the associate director of the pediatric residency program at Goryeb Children’s Hospital in New Jersey.

“The trend has been more so thinking about the amount of debt that a student has, compared to potential income in primary care,” said Winters. “But that’s not considering things like medical debt forgiveness through state or federal programs, which really can help individuals who want to choose primary care.”

KHN data correspondent Sydney Lupkin contributed to this report.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

PCPs ‘Not Doing Enough’ as STD Rates Skyrocket

There has been an “explosion in STD rates,” due, in part, to primary care physicians failing to screen their patients and discuss sexual activity.

Anna Gorman, Kaiser Health News

Julie Lopez, 21, has been tested regularly for sexually transmitted diseases since she was a teenager. But when Lopez first asked her primary care doctor about screening, he reacted with surprise, she said.

“He said people don’t usually ask. But I did,” said Lopez, a college student in Pasadena, Calif. “It’s really important.”

Lopez usually goes to Planned Parenthood instead for the tests because “they ask the questions that need to be asked,” she said.

As rates of sexually transmitted infections steadily rise nationwide, public health officials and experts say primary care doctors need to step up screening and treatment.

“We know that doctors are not doing enough screening for STDs,” said David Harvey, executive director at the National Coalition of STD Directors. The failure to screen routinely “is leading to an explosion in STD rates,” he said, adding that cutbacks in funding and a lack of patient awareness about the risks make it worse.

The federal government’s Centers for Disease Control and Prevention has set guidelines for annual screening for sexually active individuals. Among them: women under 25 should be tested for gonorrhea and chlamydia, and men who have sex with men should get tested for syphilis, chlamydia and gonorrhea.

However, testing does not always happen as recommended. For example, only about half of sexually active women ages 16 to 24 with private health plans or Medicaid were screened for chlamydia in 2015. The rate was slightly better in California.

Nationally, reported cases of chlamydia, gonorrhea and syphilis are at an all-time high, CDC data show. In one year, from 2016 to 2017, nationwide rates of chlamydia rose by 7 percent, gonorrhea by 19 percent and syphilis by 11 percent.

Rates of congenital syphilis, which passes from mother to baby during pregnancy or delivery, increased by 44 percent during that time. Nearly one-third of the congenital syphilis cases are from California. The state also saw a record number of STDs last year: more than 300,000 cases of gonorrhea, chlamydia and early syphilis among adults.

Because sexually transmitted infections are often asymptomatic, screening is essential. Untreated STDs can lead to serious health problems, such as chronic pain, infertility or even death.

“Providers and primary care providers play a crucial role in combating these rising STD rates,” said Dr. Laura Bachmann, chief medical officer for the CDC division of STD prevention. “If providers don’t ask the questions and don’t apply the screening recommendations, the majority of STDs will be missed.”

State governments don’t have enough money to combat the rising number of cases, in part because federal STD funding for them has remained stagnant, Harvey said. Last year, he said, $152.3 million in federal funding was appropriated for prevention, the same as eight years earlier.

Experts cite several reasons primary care physicians don’t routinely diagnose and treat STDs. They may worry that they won’t be compensated for providing STD services, or they may not be familiar with the most up-to-date recommendations about testing and treatment. For example, the CDC in 2015 updated the medications it recommends to treat gonorrhea.

Perhaps most commonly, many family physicians are reluctant to discuss sexual health with their patients. One study showed that one-third of adolescents had annual visits that didn’t include any discussion about sexuality.

“We’re in this situation with health care providers and patients — each waiting for the other to start [the conversation],” said Dr. Edward Hook, professor at the University of Alabama-Birmingham School of Medicine. “Doctors worry if they ask patients about their sexual history that it will somehow be offensive to them.”

Dr. Michael Munger, president of the American Academy of Family Physicians, said he remembers that his conversations around sexual health were uncomfortable at first. “There are a lot of challenging conversations you can have with patients,” he said. “But this is important. If we don’t do it, who will?”

Rob Nolan, a writer from Los Angeles, said he gets tested every six months, but he prefers to do so at the Los Angeles LGBT Center rather than during visits with his regular doctor, who rarely asks about sexual health.

Nolan, who said he has had experience with STDs, considers the clinic’s staff to be more knowledgeable about sexual health than those at a regular doctor’s office. “They just seem specialized in it,” he said. “And there is zero shame when you are in the clinic.”

Physicians also may have other, more immediate health issues to address during the short time they have with patients. Taking a sexual history and talking about sexual health falls to the bottom of many doctors’ priorities, said Dr. Leo Moore, acting medical director of the division of HIV and STD programs for the Los Angeles County Department of Public Health.

Julia Brewer, a nurse practitioner at Northeast Community Clinic in Hawthorne, Calif., said she screens for STDs as a regular part of women’s health exams. But she said her colleagues frequently refer cases to her rather than having the conversations themselves. “The family providers are overwhelmed with diabetes and high blood pressure,” she said. Sexual health, she said, can end up being an “afterthought.”

The L.A. County public health department, which identified STDs as a key priority for the next five years, recently sent representatives to doctors’ offices to teach providers how to address sexually transmitted infections. They distributed information detailing screening recommendations, sample sexual history questions and treatment guidelines.

The Los Angeles County Medical Association also plans to get the word out to doctors through social media and other efforts. “It’s an epidemic and we have to treat it that way,” said CEO Gustavo Friederichsen. “Doctors have to feel a sense of urgency.”

Dr. Heidi Bauer, who heads the California Department of Public Health’s STD control branch, said the state also is trying to educate doctors so they will screen more routinely. The department provides both in-person and online training for doctors to learn about STDs, and publishes downloadable information with current guidelines.

At the same time, Bauer urged the federal government to make its screening recommendations more comprehensive. Outside of pregnancy, for example, there are no recommendations for routine syphilis screening for women. “We are seeing this huge re-emergence of syphilis,” she said. “We haven’t been testing and syphilis is very challenging to diagnose.”

The CDC plans to review the recommendations in the next year, Bachmann said.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

The Doctor Is in, but Millennials Seem to Be Out

More millennials are shunning the traditional primary care model, in favor of retail clinics, free-standing urgent care centers, and telemedicine.

For years, office-based primary care visits have been a staple of American healthcare. However, millennials—the roughly 83 million Americans born between 1981 and 1996—seem to prefer the convenience, speed, connectivity, and price transparency of retail clinics, free-standing urgent care centers, and online telemedicine sites over traditional doctor’s appointments, reports The Washington Post.

In a national poll conducted in July by the Kaiser Family Foundation that surveyed 1,2000 randomly selected adults, it was found that 26% said they did not have a primary care provider. When that percentage was broken down by age groups, there was a staggering difference. 45% of 18- to 29-year-olds had no primary-care provider, compared with 28% of respondents aged 30 to 49, 18% of those 50 to 64, and 12% aged 65+.

A 2017 survey by the Employee Benefit Research Institute and Greenwald and Associates showed similar numbers: 33% of millennials reported not having a regular doctor, compared with 15% of those aged 50 to 64.

“There is a generational shift. These trends are more evident among millennials, but not unique to them. I think people’s expectations have changed. Convenience [is prized] in almost every aspect of our lives, from shopping to online banking,” Ateev Mehrotra, MD, an associate professor at Boston’s Harvard Medical School, is quoted as saying in the article.

This shift is upending the office-based primary care model, with more primary care practices hiring on additional physicians or nurse practitioners in an effort to reduce wait times, as well as embracing digital tools, such as patient portals, in an attempt to woo millennials back to primary care, not only for the practice’s bottom line, but for patient safety.

Some experts warn that straying from the traditional primary care model may be driving up health costs and worsening the problem of unnecessary care, including the dangerous misuse of antibiotics.

“We all need care that is coordinated and longitudinal. Regardless of how healthy you are, you need someone who knows you,” said Michael Munger, MD, President of the American Academy of Family Physicians.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Advanced Practitioners Bolster Practice Revenue, Productivity

Primary care practices with a non-physician provider to physician ratio of 0.41 or greater reported earnings of $100K+ more in healthcare revenue per physician.

A recent report from the Medical Group Management Association, which compiled data from 2,900 organizations, shows that primary care practices that employ a higher number of non-physician providers, such as physician assistants and nurse practitioners, generate greater healthcare revenue, as well as increase productivity. The 2018 MGMA DataDive Cost and Revenue report showed that physician-owned primary care practices earned $100,749 more in healthcare revenue per physician, and hospital-owned primary care practices earned $131,770 more in revenue per physician, by employing more non-physician providers, specifically a non-physician provider to physician ratio of 0.41 or greater. The data revealed that primary care practice operating expenses are increasing, as well, and have grown 13% since 2013, from $391,798 per physician to $441,559 per physician, which makes the added revenue from employing advanced practitioners essential. The data shows that leveraging physician assistants, nurse practitioners, and other non-physician providers could help medical practices overcome the growing burden of higher operating expenses, while also improving access to care and patient satisfaction.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

The Doctor Will Analyze You Now

A health center for native Alaskans brought mental and physical care under one roof, with impressive results. Why isn’t it more popular?

from Politico

As a child growing up in rural Alaska, Vera Starbard was diagnosed with major depression. She’d been sexually abused by her uncle and was plagued by thoughts of suicide. By the age of 10, she’d already spent time as an inpatient in a psychiatric hospital. “It was a really dark time,” she says. “And I didn’t feel like it was ever going to get better.”

But when she was 11, things changed. Her family moved to Anchorage, and they joined the Southcentral Foundation, a health care provider for native Alaskans. The foundation was launching a new approach to health care—one that wove mental health into the rest of its primary care.

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Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

More NPs Choosing Primary Care

In 2017, more than 89% of NPs were prepared in primary care programs.

from Clinical Advisor

Nurse practitioners are choosing primary care at a higher rate than physicians and physician assistants, according to data from the American Association of Nurse Practitioners.

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Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.