Byline: JOY BATTEH-FREIHA
Most students enrolled in medical school today have never even heard of Marcus Welby, the beloved, ever-caring, attentive television doctor.
"Marcus Welby, M.D.," which aired from 1969 through 1976, was set in a busy suburban general practitioner's office, with the older mentor physician working alongside his younger counterpart. Interaction between the family physician and his patients was reminiscent of a time when life was less hectic, a time when there were enough primary care physicians to meet the nation's health care needs.
"Most medical students enter medical school today believing in that Marcus Welby, M.D., persona," said Tim Davlantes, a family physician with Mayo Clinic Jacksonville and president of the Florida Academy of Family Physicians. "They may not be familiar with the TV series, but they care deeply for people and truly want to help ease their pain. That's the reason why most of them go to medical school in the first place."
Primary care and family care physicians, who must complete a three-year residency program after graduating from medical school, treat and diagnose 90 percent of all patient problems, according to the academy. Because of their extensive training, family physicians are qualified to treat most ailments for everyone from newborns to seniors.
But the number of family physicians has been steadily decreasing during the past 10 years, and a large percentage of the doctors now specializing in family medicine are over 50. This comes at a time when demand for their services is on the rise. William Hazel, an American Medical Association board member, called the problem "major" in a recent news release and predicted a shortage of 35,000 to 40,000 primary care physicians by 2025.
There are about 83,000 practicing family medicine physicians in the United States, according to the AMA. But a 2006 study by the American Academy of Family Physicians concluded that the United States will need more than 139,000 family physicians by 2020, not only to treat a growing population of seniors whose needs increase with age, but to provide important preventive health care, which in the long run saves on health care costs by lowering emergency room visits and some hospitalizations.
"The decrease in practicing primary care physicians and the alarming dearth of medical students planning to pursue primary care is a problem that cannot be ignored," Hazel said.
During its 2008 Interim Meeting last November, the AMA vowed to address the barriers contributing to the nationwide decline of primary care physicians, citing medical student debt, low Medicare reimbursements, recruitment and training among other issues.
According to the academy, primary care physicians are the lowest paid of the medical specialties and typically receive low reimbursements, juggle hectic schedules and are burdened with endless paperwork.
Davlantes said decreased insurance reimbursements and student loan repayments are two of the biggest issues facing primary care physicians.
"When Medicare does not reimburse the costs of many primary care procedures, these physicians are left with paying for these procedures out-of-pocket," explained Davlantes. "This can be a hardship, especially when you have a physician coming out of medical school with approximately $150,000 in student loans and not getting reimbursed for some routine procedures. The economics don't add up."
Family medicine physician Amber Isley agreed, but said another important reason for the shortages of primary care physicians is the fact that many are overextended with patients and paperwork.
"Out of all the specialties in medicine, family practice is probably the most demanding of its physicians, and the least paid of the specialities" said Isley, who is with Mayo Clinic Jacksonville. "Not only do we treat the whole patient, but we must always be on top of and up-to-date on the latest information for treating conditions such as diabetes, hypertension and breast health, to name a few. Plus, we must deal with insurance companies while serving as facilitators of good communications on behalf of our patients with other specialists."
The shrinking numbers of primary care doctors has caught the attention of President Barack Obama. In June, Obama addressed members of the AMA during its annual meeting, where he cited several challenges facing American health care and offered welcomed incentives for compensation reform as well as medical school debt.
"We need to bundle payments so you aren't paid for every single treatment you offer a patient with a chronic condition like diabetes but instead are paid for how you treat the overall disease," Obama told the group. "We need to create incentives for physicians to team up because we know when that happens, it results in a healthier patient. We need to give doctors bonuses for good health outcomes so that we are not promoting just more treatment, but better care."
Obama discussed ways to help alleviate medical school debt as well. "We need to rethink the cost of medical education, and do more to reward medical students who choose a career as primary care physicians," said Obama.
He also said his administration plans to make a "substantial investment" in the National Health Service Corps, an organization that provides primary care health services in underserved communities around the United States. Scholarships and loan repayments are offered to these clinicians to help offset debt burden in exchange for at least two years of service in a designated community.
Before returning to Mayo, Isley spent four years as a rural physician in Interlachen, working with the National Health Service Corps. "It was one of the most rewarding experiences in my career, but a frustrating one as well," said Isley. "The resources including social services are very limited in a small town."
While the AMA said most physicians view the Obama administration's strategy on health care reform and its physician incentives as a positive step forward, the immediate problem facing America's patients is a matter of supply and demand.
"We know that when you have a strong pool of primary care physicians, the results are a healthier population and decreased health care costs," explained Davlantes.
As the medical needs of baby boomers continue to rise and the available pool of primary care physicians declines, some are concerned that the health of Americans could be compromised.
"It depends on the doctor," Davlantes said, "However, I can tell you most of them [family physicians] don't stick it out [stay in practice] for the money," he added. "Sure, they need a reasonable income. They've been forced to deal with the red tape of bureaucracy and managed care, but they are healers first and took an oath to serve. Most will not sacrifice the quality of their care for their patients."
Concurring with Davlantes are the results of a 2008 survey conducted by The Physicians' Foundation of approximately 12,000 physicians, most of them primary care specialists. According to the survey, "patient relationships" rated the highest on the list of things physicians find satisfying about medicine, and "reimbursement issues" and "managed care issues" rated the highest on the list of issues physicians find unsatisfying.
"It's true," said Isley. "In spite of the long hours, the patient overload, never-ending clinics and the backlog of paperwork, there is no other profession I would rather serve than family medicine. Those who stay in the field, do so because it's in their blood and they love what they do and they do it effectively in spite of all the roadblocks."
Davlantes said while he sees challenging times ahead for his specialty, he is optimistic about the future.
"We're a specialty built on the foundation of family care," said Davlantes. "Knowing that a trusted physician will be there to help with what ails you, coordinate your health care needs, and help provide comfort, are the very aspects of what a family physician is all about."
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Mug: Tim Davlantes, president of the Florida Academy of Family Physicians
"We're a specialty built on the foundation of family care."
BRUCE LIPSKY/The Times-Union
Amber L. Isley, a family medicine physician at Mayo Clinic Jacksonville, said that despite long hours, patient overload and paperwork, "there is no other profession I would rather serve."
Graphic: MEDICAL SCHOOL GRADUATES…