A Commentary authored by Gary Freed, M.D., P.H.M., professor of pediatrics and communicable diseases at the University of Michigan Medical School suggests that adults may have a tougher time finding a doctor than children as America faces a shortage of primary care doctors. In the commentary, which appears in the May 13 issue of The Journal of the American Medical Association, Dr. Freed argues that reports on physician shortages, mostly by public bodies and policy makers, have lacked details about the specialties of primary care in which shortages will occur.
The omission could lead to the misdirection of training funds, over-saturation of physicians in areas where numbers are healthy, and lack of improvement in areas where likely shortages could pose a threat to public health.
Physician shortage reports stem from statistics showing that fewer internal medicine residents are choosing to pursue primary care and fewer medical students are choosing family medicine residencies.
Among medical students, fewer than 22% planned careers in internal medicine and fewer than two percent intended to practice general internal medicine, according to a 2008 report. Researchers have theorized this is because primary care specialties offer lower salaries
than other specialties.
These declines have not been true in the number of pediatric residents choosing primary care pediatrics. As a result, researchers believe that
discussion of shortages regarding primary care should focus on adult care rather than pediatrics.
Among pediatric residents completing training, 40% planned to pursue a career in primary care, according to 2008 data, with similar findings among senior residents scheduled to complete training in 2009.
In pediatrics, a doubling or substantial increase of the proportion of doctors entering primary care could result in a possible oversupply of primary care pediatricians, likely at the expense of needed pediatric sub-specialists.
While the number of children in the U.S. has remained stable, the number of pediatricians has increased substantially. This has resulted
in an increase in the number of primary care pediatricians from 32 to 78 per 100,000 children between 1975 and 2005. The number of pediatric
sub-specialists also increased during this period.
These changes have not so far resulted in a surplus of pediatricians and the general effect of the increase has been positive, researchers say.
Freed warns, "Increasing the number of primary care pediatricians in the pipeline could create more physicians than jobs, resulting in the opposite effect of any intended legislation or other policy solution aimed at primary care," Freed says.