Has the Demand for Primary-Care Physicians Peaked?
Cejka, Sue, Medical Economics
Primary-care physicians have been the darlings of managed care for the past couple of years.
But, to paraphrase a hit song from yesteryear, "Will they still love you tomorrow?" The answer: Maybe.
A lot depends on where you're located. If you're a family practice resident in Chicago or a solo internist in Atlanta who seeks to join a group, your phone may still be ringing off the hook-for now. But your counterparts in Los Angeles and New York are seeing the demand for their services plummet. Those markets are glutted. Other urban areas will follow.
Yet a 1996 survey report from the Council on Graduate Medical Education predicted a shortage of 48,000 generalist physicians by the year 2000, falling to 39,000 a decade later. While this would suggest continued feast rather than incipient famine, consider the following:
Nationwide openings for primary-care physicians have already declined. Our company is the largest physician-recruitment firm in the U.S. Sixty percent of the positions we're trying to fill nationwide are for primary-care physicians. That's good for you. However, we also conduct an annual Recruitment Practices Survey that tracks physician job opportunities from year to year. From 1995 to 1996, openings for primary-care physicians declined 18 percent. That's not a good sign.
Some places have too many doctors. If you head for the less-populated, more rural parts of America where the physician-patient ratio remains low-states like Alabama, Arkansas, Idaho, Mississippi, South Dakota or Wyoming-you're apt to find intriguing opportunities well into the next century. But if you have your heart set on Boston, Los Angeles, New York, San Diego, San Francisco, Philadelphia, Seattle, or Washington, D.C., be prepared to take what you can get-if, that is, you can even find a job. Such places are drowning in primary-care physicians, competition is fierce, and the situation isn't likely to improve.
The demand for primary-care physicians may be overstated. Estimating future demand is always a tricky business. Let's say that three competing hospital systems in a given region separately determine that the area requires 200 more primary-care physicians. Each then sets out to hire, acquire, or affiliate with the doctors needed to make up the shortfall. Within a year or two, each system now has its 200 additional primary-care physicians in place. The problem is that they've collectively added 600 doctors, not the 200 that the area required. That's how yesterday's drought can become tomorrow's flood.
MCOs are starting to say, "You can be replaced." You may work with nurse practitioners and physician assistants and consider them a blessing. Cost-conscious managed-care organizations are taking your point. Increasingly, they're saying, "Why pay three primary-care physicians $125,000 apiece to do what one physician and two midlevel providers can accomplish, particularly since the latter cost only half as much?"
Not only can these skilled professionals perform routine care, but they're often more willing than physicians to move to underserved areas. But physicians may change their tune about these locations when, unable to find the employment they want in popular urban areas, they begin to look elsewhere-only to find physician extenders already entrenched. …