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

[RedHead0186]

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.

I can speak a bit to the residency part. Once a resident matches to a particular residency, they are committed to it at least for the first part. And residencies are in specific specialties, so if you match into, say, internal medicine, that's your specialty. It does happen that residents transfer to other residencies in other specialties, but that usually sets them back in terms of graduation requirements and eligibility for board certification. So yes, I can imagine that by the time future doctors get to residency, they are a bit 'locked in.'

 

[LuvOrlando]

A lot of people mentioned lowering the cost of medical school. In the US education is a private industry so there is no real way to regulate it. However, that doesn't mean it can't be influenced indirectly, in the US things get "helped" all the time with financial incentives when you check certain boxes etc, it is the way it is. With this issue I imagine the biggest reason for it being neglected is that the leaders and decision makers aren't as exposed to the problem as everyday people outside the loop.... at least not yet but it's looming for them too.

I'm actually flying back to PA soon to see my long time GP because I haven't found anyone who can hold a candle to him and I have tried, it is all just so bananas.

 

[JAMIESMITH]

I'm not seeing anyone mention nurse practitioners. In our area one general practitioner will oversee several nurse practitioners who are basically acting as general practitioners. They are able to work as nurses and have an income while they get the degree required to be a nurse practitioner. They have less total schooling than any doctor so it's less expensive. They have the option to bring in the general practitioner if needed.

 

[Mackenzie Click-Mickelson]

I'm not seeing anyone mention nurse practitioners. In our area one general practitioner will oversee several nurse practitioners who are basically acting as general practitioners. They are able to work as nurses and have an income while they get the degree required to be a nurse practitioner. They have less total schooling than any doctor so it's less expensive. They have the option to bring in the general practitioner if needed.

For a large portion of my life I only saw an NP, I hardly ever saw my actual pediatrician I just saw the NP for example. But I think the medical industry itself has also gone to looking at specialized places as in instead of vast amounts of generalized employees there are more referrals to a specialized person someone would see. I'm not sure that's a bad thing if it's more about seeing that conditions can be treated better or understood better when it's able to be looked at by someone who specializes in that. I just tend to see more "I was referred to X for this and then referred to Y for that".

 

[tvguy]

A lot of people mentioned lowering the cost of medical school. In the US education is a private industry so there is no real way to regulate it. However, that doesn't mean it can't be influenced indirectly, in the US things get "helped" all the time with financial incentives when you check certain boxes etc, it is the way it is. With this issue I imagine the biggest reason for it being neglected is that the leaders and decision makers aren't as exposed to the problem as everyday people outside the loop.... at least not yet but it's looming for them too.

I'm actually flying back to PA soon to see my long time GP because I haven't found anyone who can hold a candle to him and I have tried, it is all just so bananas.

There are an awful lot of public medical schools. UC Davis here for example. UCLA, etc.

 

[tvguy]

One thing my wife and I have run into is there are a lot of part time Doctors. My nephrologist only works every other week. Not sure if this is by her choice, or if that is how many hours the practice she is part of is willing to pay for. My wife's GP only works 3 days a week.

 

[LuvOrlando]

One thing my wife and I have run into is there are a lot of part time Doctors. My nephrologist only works every other week. Not sure if this is by her choice, or if that is how many hours the practice she is part of is willing to pay for. My wife's GP only works 3 days a week.

My Immunologist is 10% Dr and 90% researcher, maybe it is common now for hospitals to be dividing up their time with research or between different facilities in some way? My MIL has a Dr come in one day a week to her Elder Care facility so that Dr must be doing something else the rest of the week. Many Dr's are also medical school teachers so I imagine that is another drain on practicing hours.

 

[tony67]

One thing my wife and I have run into is there are a lot of part time Doctors. My nephrologist only works every other week. Not sure if this is by her choice, or if that is how many hours the practice she is part of is willing to pay for. My wife's GP only works 3 days a week.

Many times they work at different places on different days.

My brother is dealing with many doctors currently and they are all never in the same office on the same day so he ends up with multiple appoints on different days. He is terminal and does not want to drive or deal with going into the city so that limits him even though we are a mile for a major hospital. Many times he did go into the city they would do blood work and say he cant get treatment so its just not worth it.

Anyway many docs work a few days at the hospital, a few days in a local office and then a few days in an office that is in the city.
This is not unusual from what I see.

I know one GP who does not work till noon and works 3.5 days a week.
That 5th day is often doing paper work or writing up things for court cases etc..
So even though he does not have office hours he is still working and often working at night or weekends on paperwork.
Also has to work on Saturday a month in the hospital. And of course if one of his patients has an emergency he needs to be able to respond. He is in a small town so he has to be responsive to folks.
Without a doubt its over 40 hours a week and much of that time is not really paid.
After many years in private practice they are finally at a point where they are comfortable, but at that point you are getting ready to retire.

In general I think GPs are grossly underpaid, again, not just in the US.
If you want to make money you really need to be a specialist, so for many that is they way to go instead of GP.

 

[lanejudy]

One thing my wife and I have run into is there are a lot of part time Doctors. My nephrologist only works every other week. Not sure if this is by her choice, or if that is how many hours the practice she is part of is willing to pay for. My wife's GP only works 3 days a week.

While it's possible your providers are actually part-time, it's more likely they only see patients in that office part of the time. They may work certain days/hours at the hospital and/or another office location. That's very common here for both specialists and primary care. My daughter's pediatrician could be found at 3 different office locations depending on the day of the week. Even some providers at my PCP do some hours at the Urgent Care so they are only in the office for patient appointments what appears to be "part-time" but in reality working way more than 40 hours/week.