Andrew Fisher wants to be the kind of physician the United States sorely lacks, but he is keeping his options open, depending on how health care reform evolves.
The 32-year-old native Minnesotan has a year left in his residency program as a primary care doctor at the University of Pittsburgh Medical Center, concentrating on elderly patients.
"Why primary care? I wanted to do something that would help people who need care, and I feel like I'm doing that," Fisher said. "I'm treating the older and sicker."
Fisher's plan to serve as the initial stop for the ailing elderly in the health care system is a mindset that experts say is seriously lacking among the nation's young doctor population.
The Association of Medical Colleges projects that by 2025, there will a nationwide shortage of 46,000 primary care doctors.
Pennsylvania had about 16,300 primary care physicians in 2008, according to data from the Kaiser Family Health Foundation, the most recent available. Based on current need, a University of Pennsylvania expert estimates the state's current shortage at about 1,000 primary care doctors, or about 7 percent of the total.
The shortage of primary care physicians is attributed to many reasons. Among them are low compensation compared with specialists, a lack of interest by medical school graduates, liability problems and a growing number of primary care doctors opting for early retirement. How primary care is viewed, discussed and taught in many medical schools, is cited.
"Primary care is one of the lowest paid physician professions today," said Ralph Schmeltz, for more than 40 years a practicing internal medicine doctor prior to retiring last July, and president- elect of the Pennsylvania Medical Society.
Health care reform's mandate that all Americans have health insurance soon will run into the reality of a lack of new primary care doctors such as Andrew Fisher at all levels.
An estimated 32 million people nationwide will be added to insurance rolls within the next five years, the result of health care reform signed into law in March. In Pennsylvania, the number of uninsured is estimated at about 1 million, according to the state Department of Health.
Primary care practice includes family, general internal medicine, general pediatrics and geriatric physicians.
"We see the shortage in Pennsylvania climbing to 20 percent from about 7 percent over the next decade, without the impact of health care reform, which we don't think will make a huge difference," said Richard Cooper, a retired oncologist and current professor of medicine at the University of Pennsylvania in Philadelphia.
"The major issue won't be how many more people will seek care, but how many more people will be alive and need care," said Cooper, who serves as co-chairman of the Council on Physician and Nurse Supply.
Some health care industry experts see the combination of added patients and a primary care physician shortage resulting in no solution to the existing health care situation.
Even with some form of insurance coverage, thousands of Pennsylvanians and millions of Americans may continue visiting hospitals when care -- …