This report originally appeared in the September 2009 issue of DOTmed Business News

Health care in the U.S. represents about one-sixth of the economy and a strong source of job growth in a tight labor market. But it's a "careful-what-you-wish-for" bright spot in a slow economy. By all indications, filling tomorrow's needs for health care professionals will be a great challenge for the nation's hospitals and other health care providers.

The clarion example is the anticipated shortage of primary care physicians. It is accepted wisdom that to rein in health care costs patients need a "quarterback" to coordinate their care, particularly in chronic disease prevention and management. Chronic diseases account for 70% of all deaths in the United States and the care costs for people with chronic diseases account for more than 75% of the nation's $2 trillion medical care costs, according to the Center for Disease Control (CDC).
The American College of Physicians warned in 2006 that primary care was on the verge of collapse and more recently reported on how little has been done about it. "The United States has yet to implement comprehensive strategies to recognize, support and enhance primary care to the degree necessary to reverse a worsening primary care shortage," states the ACP in a recent white paper: How Is a Shortage of Primary Care Physicians Affecting the Quality and Cost of Medical Care?

Today, physicians represent about a 60/40 split between specialists and primary care doctors, an imbalance brought about by higher pay incentives to enter specialties. Specialists earn about twice the pay of general practitioners according to the Bureau of Labor Statistics (BLS.gov). Heavy medical school debt causes a disproportionate number of M.D.s to pursue specialties.

Why should hospitals or medical facility administrators care about this? After all, they aren't in the business of providing primary care. Yet, the burden of the uninsured, combined with America's primary care crisis has transplanted primary care to tertiary care facilities. As the ACP white paper documents, patients living in areas with primary care shortages are at higher risk for preventable hospitalizations.

Meanwhile, we can't lose sight of shortages in medical specialties.

"Physician shortages extend far beyond primary care and have already been reported in 19 specialties as varied as emergency care, general surgery and child and adolescent psychiatry," J. James Rohack, M.D., President, American Medical Association, indicated in a recent letter to the Dallas Morning News. Dr. Rohack recommended increased funding for the National Health Service Corps to address the primary care problem. He also wants to lift the cap on government-funded medical residency slots. "We must seize this opportunity for comprehensive health reform to ensure there are enough physicians to care for all of America's patients," he noted.

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