What might a good solution be to the General Practitioner Shortage in the US?

[Starport Seven-Five]

Reduce cost of schooling, make health insurance companies obsolete, get rid of regional healthcare conglomerates, reform malpractice insurance, etc.

The American healthcare system has been a mess for a while and it seems to only be getting worse. I can see why less people are going that direction.

 

[VandVsmama]

In the US General Practitioners are the gateway to mental health care, many specialists and all sorts of other kinds of medical care. We have Urgent Care all over the place but since Urgent Care does not do followup of any kind they are't there to offer ongoing care for things like Depression etc or ongoing issues while a person waits to get into a specialist which can take months.

One of my adult children has been trying to get into a Primary Care - General Practitioner in Boston for over 2 years, yep, two years. I just spoke with someone in office staff who tole me there is a hold because so many retired during Covid and no new students want to go into the area. I just found an article saying the biggest system in the area was full back in 2023, https://www.nbcboston.com/news/loca...-accepting-new-primary-care-patients/3191270/ seems like nothing has changed which is scary still not taking patients. This is a big city with countless new residents, students and just just a massive a flux of humans so how can it be no-one is available to see people, not to mention some serious social issues with a substance abuse and homelessness in play

How can the US or struggling cities or states coax students into Primary Care? My best guess is to grant them student loan forgiveness if they commit for 5-10 years. Maybe another option is the laws change requiring Urgent Care to do follow-up? Maybe some states have made progress or brainstormed something because yikes, this needs to be remedied, the situation is terrible.

Some info & thoughts to consider:

• there's a federal program called the Public Service Loan Forgiveness program. Info available about it at https://students-residents.aamc.org/financial-aid-resources/public-service-loan-forgiveness-pslf. Requires an application.
• Some states have their own similar program. Arizona (where I live) has one and it applies to several types of healthcare jobs. Not only MD/DO's, but nurses, NPs, PAs, dentists, pharmacists, psychologists. https://www.azdhs.gov/documents/pre...ams/loan-repayment/arizona-loan-repayment.pdf
• Indian Health Service (IHS) also has a healthcare loan forgiveness program. https://www.ihs.gov/loanrepayment/
• Some COUNTIES might even have specific programs like this, too.
• Many healthcare systems are switching to use more NPs and PA's for primary care.
• The medical practice specialty of "General Practitioner" is kind of going away. You're more likely to find someone similar to this by going with an MD/DO whose specialty is Family Practice or Internal Medicine.
• Laws requiring an urgent care facility to do follow up isn't going to fix the problem. Urgent care is not meant to be used as ongoing care. What you'd end up doing is clogging up urgent care facilities so much that people with an ear infection will end up going to the ER instead and then ER wait times will go up more than they already are.

 

[LuvOrlando]

I'm not certain about MDs but I know for a fact Georgia has a similar program for dentists graduating from the state dental school in Augusta. Newly graduated dentists have been offered full tuition forgiveness if they move to a specified area and practice there for (I think) 8 years. My husband is a dentist and has gotten several student accepted to dental school in Augusta. A few of those students have been offered an amazing deal where a practice is set up for them, they are paid a very good salary (6 figures) and the state pays their outstanding college loans. My husband told each of those new dentists that they should accept that offer, work out the term, even if they work 3 or 4 days in the under served area and 1-2 days in the area of preference to establish themselves for when their contract is over. No one that he knows has taken the offer.

That's unfortunate, I wonder if this is largely due to the advanced age when a Dr will graduate. Once you are knee deep in medical school you already have a strategy and a plan to get to the other side that is keeping you going, might even have a significant other and made promises so another shift is very tough.

I imagine that this brilliant program would do much better if offered to younger students who don't have a plan yet so this becomes their plan. Float this around a bunch of new bachelors graduates worried about their loans and many might get wooed away from other disciplines.

 

[LuvOrlando]

Every type of doctor we have needed in more than 5 years is in short supply.

And everything already said in this thread is spot on.

One of our kids is in medical school. But has joined the US Navy so that the Navy will pay for school. Don't count on them treating civilians until after school, residency, and their obligation to the US military.

Their med school alone would be $60,000 per year.

There are states with programs for doctors to treat in rural areas and get some school paid for.

But medical schools have limited number of seats for medical students and have a cap on the number of incoming students they can accept. That's part of the reason medical school is hard to get into. There are just not enough openings for everyone.

It does make sense to open up many more schools to keep up with population growth, good point.

 

[China Expat]

Medicaid cuts are coming in 2026...this will make access to medical care even more difficult.

 

[tony67]

So just to say it yeah the whole system with PCP is a big problem, but its not just in the US.
It can also vary by state - the closest PCP I could get for about 10 years was 60 miles away in another state.
There was a PCP in my town, but he was about 80 and not very competent IMO.
BTW - I live in a town with a major hospital for the entire county - still no PCP.
Then when you finally get a PCP it takes 9 months for an initial visit and they wont do much for you until that visit.

All that said other countries have the same issues with GPs - its not just a US problem regardless of what some want you to think.
So even in countries where education is basically free many of the slots go to foreigners who pay.
So for example an American who could not get into med school but has money can pay and get in elsewhere taking a slot that would have been used by a local.

Then on top of that the folks that do graduate have countries like Australia recruiting GPs from other countries as well, so even though a country is qualifying GPs they are going to Australia where they have better weather, better pay, better opportunities.
Its very tempting for most. I personally know multiple GPs (and nurses) who have done this.

 

[LoveDaisy]

Change in the cost of higher education, changes for malpractice insurance, salary, and changes within the government to support science.

 

[Bad Pink Tink 2.0]

Then on top of that the folks that do graduate have countries like Australia recruiting GPs from other countries as well, so even though a country is qualifying GPs they are going to Australia where they have better weather, better pay, better opportunities.
Its very tempting for most. I personally know multiple GPs (and nurses) who have done this.

I was just about to say this. Other countries who have medical personnel shortages have recruitment programs in various countries. Australia is just the high profile one right now. Since the late 1990's Ireland has been recruiting Filipino nurses. This is the Irish Governments Recruitment page for international medical personnel. https://www.hse.ie/eng/staff/jobs/overseas-candidates/

Some things that the Irish Government offers as part of the recruitment package.

• The relocation package provides an allowance towards flight and accommodation costs up to the value of €4,160 for EU/UK candidates and €4,710 for Non-EU candidates
• Payment of Registration fees to Regulatory Bodies
• Payment Visa Fees
• Payment of Royal College of Surgeon (RCSI) Ireland Aptitude Test Fees/ other required registration fees
• Payment of Philippine Overseas Employment Administration (POEA) Language Testing and Examinations for the purpose of registration
• Payment of Recognition Fee / Validation of Qualification fee
• Payment of Atypical Working Scheme (ATWS) fee

Being mindful of Dis rules, and trying to be careful with my words. The Irish Government welcomes international medical personnel and makes it easy for them to come here as well as helping with the costs of relocation. This gives an immediate boost in numbers of qualified medical personnel which then supplements the Irish medical personnel who graduate each year. This is how you fill a deficit in an industry.

 

[SueInBoston]

In the US General Practitioners are the gateway to mental health care, many specialists and all sorts of other kinds of medical care. We have Urgent Care all over the place but since Urgent Care does not do followup of any kind they are't there to offer ongoing care for things like Depression etc or ongoing issues while a person waits to get into a specialist which can take months.

One of my adult children has been trying to get into a Primary Care - General Practitioner in Boston for over 2 years, yep, two years. I just spoke with someone in office staff who tole me there is a hold because so many retired during Covid and no new students want to go into the area. I just found an article saying the biggest system in the area was full back in 2023, https://www.nbcboston.com/news/loca...-accepting-new-primary-care-patients/3191270/ seems like nothing has changed which is scary still not taking patients. This is a big city with countless new residents, students and just just a massive a flux of humans so how can it be no-one is available to see people, not to mention some serious social issues with a substance abuse and homelessness in play

How can the US or struggling cities or states coax students into Primary Care? My best guess is to grant them student loan forgiveness if they commit for 5-10 years. Maybe another option is the laws change requiring Urgent Care to do follow-up? Maybe some states have made progress or brainstormed something because yikes, this needs to be remedied, the situation is terrible.

I've been trying for over 3 years for myself and my 78 year old aunt. I just finally got an appt for my aunt (we had the same PCP who left St Elizabeth) with a Geriatric practice. They seem to have availability each year.
Yes, I am just praying that I stay healthy.

 

[LilyWDW]

It does make sense to open up many more schools to keep up with population growth, good point.

Where does the funding come from? How do you get faculty?

 

[Mackenzie Click-Mickelson]

The Irish Government welcomes international medical personnel and makes it easy for them to come here as well as helping with the costs of relocation. This gives an immediate boost in numbers of qualified medical personnel which then supplements the Irish medical personnel who graduate each year. This is how you fill a deficit in an industry.

You act as though Ireland is the only place this exists. You do realize the U.S. does this quite a lot too right? It is normally field/industry specific. Engineering is one of the biggies, Tech is another one.

None of my husband's engineering professors were from the U.S. for example.

In my direct area one of the cities the southern part of it has a high population of people from India in the tech field and because of that many apartments and other rentals have concessions made for them if they need to break their lease (something that normally is costly) to relocate at a moment's notice.

 

[Mackenzie Click-Mickelson]

That is why Canadian med school graduates cannot practice in the US without completing additional training inside the US.

To be fair this happens all over the world and across various industries. Reciprocal degree acceptance just varies. Different countries have different qualifications for what constitutes a degree in X which may not match what another country views it as. So subsequent training is required in those cases. Though I do understand your point I might phrase it as the barrier is lower in Canada due to tuition costs compared to what others in the thread were mentioning.

The same can be said for the U.S. where we have different rules for what qualifies someone that may not carry over to another state. One of the big ones in the pandemic which has carried over after that is childcare. I know my state (not without controversy) lowered the required qualifications for childcare licensing in order to try and help the shortage. I can't say that people en masse want that to happen on a large scale with the medical field but that is one way, maybe looking at low-stakes requirements that wouldn't affect in an appreciable way knowledge and experience.

 

[Bad Pink Tink 2.0]

You act as though Ireland is the only place this exists. You do realize the U.S. does this quite a lot too right? It is normally field/industry specific. Engineering is one of the biggies, Tech is another one.

None of my husband's engineering professors were from the U.S. for example.

In my direct area one of the cities the southern part of it has a high population of people from India in the tech field and because of that many apartments and other rentals have concessions made for them if they need to break their lease (something that normally is costly) to relocate at a moment's notice.

Like I said, I am choosing my words carefully being mindful of the Dis rules, so there is a lot I am choosing not to say. I gave an example of what my country is doing for medical personnel, as the topic of this thread is about medical personnel. I choose to give a positive example instead of being negative about America and issues with H-1B visas in 2025. How you choose to interpret my words, when I am being very mindful of Dis rules, is up to you

 

[mom2rtk]

Where does the funding come from? How do you get faculty?

From the tuition the students would be paying.

 

[jimmymc]

Make medical school more affordable and treat residents better. It's such a simple solution that nobody actually wants to implement.

 

[Mackenzie Click-Mickelson]

Like I said, I am choosing my words carefully being mindful of the Dis rules, so there is a lot I am choosing not to say. I gave an example of what my country is doing for medical personnel, as the topic of this thread is about medical personnel. I choose to give a positive example instead of being negative about America and issues with H-1B visas in 2025. How you choose to interpret my words, when I am being very mindful of Dis rules, is up to you

Nah, you ended it with "This is how you fill a deficit in an industry." speaks for itself. The fact that you even have to preface this above comment by saying "I choose to give a positive example instead of being negative about America" also speaks for itself.

You really don't even have to touch on politics here which also speaks to itself as to your assumptions. It's not novel that countries have situations where they pull from other countries. Whatever administration is there at that moment doesn't make it as if poof only Ireland is the only one to do it. If instead you showed curiosity into what the U.S. does without derision..

 

[longboard55]

Hate to go there but a lot of medicine should be done online with a nurse. And using AI would make it even more effective. We saw a little during covid. Even checkups, basically they get blood and check your blood pressure. If there is nothing changed why see a doctor. And it would be fairly easy to do a machine that listens to your heart online.


Lets see, I fell off my horse and can't put weight on my ankle, do we really need a doctor to tell us we need an xray, can't we just skip that step. A lot of illness would be better treated by getting to it early online, instead of waiting to see if you are really sick enough to see a doctor and wait for an appointment.

 

[NotUrsula]

In the US I think we should go more in the direction of shortening the educational path the way that it is done in several other countries. There is still just as much medical education, but it starts sooner. For instance, in the UK one does not typically start medical school at age 22; it's normally age 18. They skip requiring physicians to first earn a bachelor's degree, but the residency period is longer. I don't see why we cannot have more schools that do it this way, as long as the graduates can pass the licensing exams. (We do have a handful of schools that do a 6-year path that starts the intensive medical training in the 3rd year of college, but that's not really equivalent to starting at age 18.)

The US does still have some hospital-based training for nurses; a holdover from the days before being an RN typically was achieved by earning a BSN before taking the Boards. I just looked it up, and US nurses who do the ADN path to becoming an RN instead of earning an initial BSN typically make about $70K to start, which is approximately $18K less per year than those starting with the BSN. Since there are very few scenarios in the US where college costs less than $18K/yr, many people would say that starting through the more old-style ADN path makes more financial sense in many cases. (In my family I'm one of very few female non-nurses, and this path is typical for my relatives. Almost all of them ended up earning the BSN part-time later on, because the credits taken for the ADN do usually count toward it, and the hospitals encourage them to do it.)

Of course, job one is getting the cost of medical school (and higher ed in general) down to a livable level in the first place. That really isn't as far-fetched as most people think, because there is a really straightforward reason why education costs have risen so exponentially since the 1970s. The primary reason that public higher ed costs so much in the US is due to tax cuts that eliminated the majority of former government support for public higher education over time. When tax support was cut, the schools had to put more of the burden on students to directly pay classroom costs. (And before anyone says that is a political statement, it isn't. It's just fact.)

PS: While referring to a university as an SEC school is a sports reference (it refers to the National Collegiate Athletic Association's Southeastern Conference subgroup), in much of the US Deep South, it's also a shorthand way of referring to the Flagship Public Universities in the region, because most of the schools in the SEC are also the state public flagship schools. (There are some exceptions, however; in four states more than one university is an SEC member school, and Vanderbilt is private. The non-flagship public member universities are Texas A&M, Auburn (in Alabama), & Mississippi State.)

 

[tvguy]

The problem is MONEY. The solution, a compromise on the following issues:
1) Medical School is too expensive.*
2) Medical insurance is too expensive.**
3) Doctors make far less than they used to.
4) Insurance companies pay too little for services

*I can only speak for myself, but none of my Doctors went to medical school in the U.S. My Primary went to Medical school in Japan. One specialist went to Medical School in the Philippines. Two of my specialists went to Medical School in India. And one specialist went to medical school in Vietnam. So maybe part of the problem is U..S Medical schools are too expensive.


**A friend is turning 65 in a few months and is getting ready to sign up for Medicare. As an adult, she NEVER had health insurance until the Affordable Healthcare act. So she has had health insurance for 12 years, since she turned 53. She was paying $10 a month but upgraded to a better plan to the tune of $50 a month. She is trying to budget for Medicare, Part B which will cost $206.50 starting January 1. A medigap policy will add about $150 a month to that cost. A HUGE increase for her. Yet for my wife and I, that is a huge DECREASE from the $600 a month each we were paying before Medicare. And a lot less than the $1,500 I would have been paying for private insurance. And a lot of people don't realize, when you turn 65 you no longer qualify for Affordable Health Care coverage, you HAVE to move to Medicare.

 

[barkley]

we've seen a trend in our region-lots of younger general practitioners leaving medical groups to go off and pursue other specialties. I don't know what the deal is except that maybe what they perceived as their professional lives looking like not being the case (it seems in recent years that what was traditionally the role/duties of the gp became the role/duties of the the nurse practitioners with the doctor largely doing only the appointments absolutely mandated by insurance be conducted by a doctor-beyond that it seems admin heavy).

I don't know what residency looks like for a gp-maybe it's not accurate to the realities of the day to day job? does it occur so late in the prolonged educational process that a med student feels 'locked in' at least for the earliest part of their careers and go into it already awaiting the opportunity to leave? it seems like some other professions have done well by changing up their educational systems to earlier integrate some aspects of the real day to day aspects of the career-the nursing programs near us report that students seem to benefit by working their way up to their rn as they combine work with education, the number of teaching graduates who actualy go into and stay with teaching seems to have increased with programs that have students in some aspect of classroom work long before the 5th year that was common when I got my credentials in the '80's (lots of people including myself found that what we had been taught in no way reflected the realities of k-12 teaching and sought other careers), and my former employer found much greater success in retention of social work staff by participating in a local university's hybrid program that integrated on the job experiences/exposures to the day to day from the begining.