Are Primary Care Physicians Going the Way of the Dinosaurs?

By Petrick, John | The Record (Bergen County, NJ), March 10, 2016 | Go to article overview

Are Primary Care Physicians Going the Way of the Dinosaurs?


Petrick, John, The Record (Bergen County, NJ)


It should have been a prideful occasion. Dr. Adam Jarrett, who was in the very first class of residents at New York Hospital- Cornell Medical School in 1992 to train in a new program focusing on primary care, was recently invited back to his alma mater. He was there to discuss job opportunities with a group of fresh-faced primary care students getting ready to go out into the world themselves. There was just one problem.

"I don't think there was a single person in the room who wanted to pursue primary care. Some were going on to law school, some were going to work for the FDA, some were going into hospital administration," he said. "This was the creme de la creme of the class. And at some earlier point they all at least THOUGHT they wanted to do primary care because they went into a program geared toward it."

So what happened? Is primary care no longer that "primary"?

For the moment, not really, medical field observers say. Some say they may become extinct, being replaced by the likes of nurse practitioners or doctor's assistants. But others maintain that an anticipated revision of conventional insurance rules that reimburse for results and continued wellness over performed procedures could bring back primary care physicians as Numero Uno in a patients' stable of doctors.

Jarrett himself left his primary care practice 12 years ago to go into hospital administration. He now serves as chief medical officer and executive vice president of medical affairs for Holy Name Medical Center in Teaneck. He will not say that economics was necessarily a factor in his decision to change career paths. But be that as it may, he's making a heck of a lot more money now than he was then.

Some observers say that hundreds of thousands of dollars in student loan debt after college and medical school is driving more and more students to the higher-paying specialty fields, as opposed to primary care (composed of family medicine, internal medicine and pediatrics).

A new report from the Association of American Medical Colleges found that there are only 91.1 active primary care physicians per 100,000 people in the United States. By 2025, the U.S. is expected to see a shortage of roughly 65,000 primary care physicians, according to the AAMC.

"It is true that there is a shortage of primary care physicians, and it is looming to be even greater," said Dr. Fred Jacobs, executive vice president of St. George's University in Grenada and chair of its Department of Medicine.

Experts say the current model is one in which doctors are reimbursed more for conducting procedures or surgeries than for overall wellness management, which is why the PCP loses out over, say, the heart surgeon or the oncologist. And yet, overseeing a patient's overall good health is crucial. "Primary care physicians play the most important role in your health care. Your primary care doctor is your navigator, the one who assists you in making decisions for the rest of your life. They help you pick specialists, as they know who all the really good specialists are," Jarrett said.

"Now your doctor has been taking care of you for 20 years and you are 80 now. Who better than the doctor you have been seeing for 20 years, two to three times per year, to help you make end-of-life decisions? And yet having those conversations doesn't get reimbursed nearly as much as getting your gallbladder taken out," Jarrett added. "Not that I am making any judgments here. …

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