Is There a Shortage of Primary Care Physicians? Becker

Until the early part of the twentieth century, practically all physicians in the United States and elsewhere were primary care physicians, not specialists. This changed dramatically in all developed countries over the remainder of that century, so that at present, over 75% of all American doctors specialize in fields like surgery, cardiology, dermatology, urology, and oncology. Specialization in Europe also grew over time, but at a much slower rate than in the United States, the result being that European medicine is practiced with relatively fewer specialists compared to generalists.

The growth in medical specialists over time is largely explained by the general economic theory of specialization and the division of labor. Medical specialization becomes more attractive when spending on medical care increases since a bigger market for medical care provides even highly specialized physicians a large enough market for their services. This conclusion is an application of Adam Smith’s famous dictum in the Wealth of Nations that the division of labor is influenced by the extent of the market. Since medical spending per person and in the aggregate is much higher in the United States than other countries, it is no surprise that American specialization is much greater than elsewhere.

The great advances in medical knowledge, especially since the 1950s, also contributed to the growth in specialization. For it takes expensive and very time-consuming investments by young doctors as medical residents and in other ways to gain command of the extensive information needed to practice modern surgery, oncology, cardiology, and other specialties. Specialization also increases when the ability to coordinate different specialists and generalists improves. That has been happening in the medical field with the growth of online records that transfers information among different specialists and generalists who are caring for the same patients, and especially with the development of group practices and medical centers that enable patients to visit different specialists and generalists in the same suite of offices or in nearby buildings.

Levels of compensation, as determined by the forces of supply and demand filtered through government policies and private insurance companies, also determine the degree and types of specialization. For medical students respond to the financial returns and other conditions found in different specialties and in general medical practice. In one important respect at least, as Posner indicates, the health care changes enacted into law by Obama will increase the demand for primary care physicians by providing subsidized medical insurance for over 30 million generally younger persons who have been without medical insurance. Young people primarily use medical care to treat the flu and other respiratory diseases, to receive general medical checkups, to treat the effects of accidents, and to get help on other medical problems that mainly involve visits, at least initially, to primary care physicians. However, the further growth over time in spending on the elderly through Medicare and private insurance will primarily increase the demand for cardiologists, oncologists, surgeons, and specialists in geriatric medicine.

Is there a “shortage” of primary care physicians relative to “shortages” of specialists? I am doubtful for several reasons. Many specialists also engage in general medical practice, especially among patients who initially come to them for specialized treatment, but who then receive medical care for medical problems that are the main business of general practitioners. This ability of specialists to also practice general medicine enables specialists to fill out their working days, and also tends to prevent any excess demand for primary care physicians from getting too large relative to the demand for specialists.

If this conclusion is correct, waiting times to get appointments for visits to general practitioners should not be significantly longer than the waiting times to get appointments to specialists. A 2009 survey by Merritt Hawkins, a healthcare consulting company, estimates willingness to take Medicaid patients and also waiting times in 15 metropolitan areas for cardiologists, dermatologists, orthopedic surgeons, obstetricians/gynecologists, and family practitioners. Willingness of general practitioners to take Medicaid patients is not lower than that of these specialists, with the exception of cardiologists.

 

While waiting times vary greatly among these areas, they are not systematically longer for family medicine than for the specialties surveyed. Waiting times are much longer for the Boston area than in any other area perhaps because of the vast expansion in health coverage in Massachusetts during the past decade. The wait times averaged over all the metropolitan areas vary by category of medical practice, from 16 days in cardiology to 28 days in obstetrics/gynecology. Family practice is in the middle at about 20 days. There appears to be a tendency for the categories with generally more urgent needs, like cardiology, to have the shortest waits, and those with the least urgent needs, like dermatology and obstetrics, to have the longest waits.

Much more evidence is needed on both wait times and salaries to reach definitive conclusions about shortages in different medical markets. However, these waiting time data suggest that substitution on the part of patients between family practitioners and specialists who can offer similar services, and arbitrage among medical students in deciding which fields to enter, prevents the development of particularly large “shortage” of general practice physicians.

 

 

 

 

Comments

[water removal]

The Most Helpful Restoration Service in America - Affordable Services in Your Area - 24/7 Hotline.

[track mounted crusher]

I love reading through your blog, I wanted to leave a little comment to support you and wish you a good continuation. Wishing you the best of luck for all your blogging efforts.

[mbt online]

well this blog is great i love reading your articles.

[Medigap]

The longer days, lower pay, less prestige and more administrative headaches have turned doctors away in droves from family medicine, presumed to be the frontline for wellness and preventive-care programs that can help reduce health care costs. This is proven by the decline in the number of students going into primary care has dropped 51.8% since 1997.

[nike shoes]

Thanks for division this attractive post. There are some points here that I have not hear of earlier than. Perfect!Just keep your work!Once again, thanks for this useful post. This will be very helpful for me.

[nike shoes]

Thanks for division this attractive post. There are some points here that I have not hear of earlier than. Perfect!Just keep your work!Once again, thanks for this useful post. This will be very helpful for me.

[günstige ugg]

Troy Davis vollbracht hatte an diesem Abend Zeit für Ihre Tötung eines Polizist außer Dienst auf folgenden von der Ough. UTES. Supreme, [url=http://www.uggkaufen.net/]ugg stiefel[/url] , dissmissed Richter aus jedem Last-Minute-Aufenthalt mit der Leistung in der Mitte des weit verbreiteten Gericht Fragen der Schuld verbunden. Davis, 44, Vergangenheit weg mit 14: 08 Uhr ET, auf ein neues Georgien Team von Korrekturen Basis befürwortet. Ihr Sterben durch giftige Behandlung kamen nach einer starken etwa vier Stunden für autorisierte Prüfung zu verschieben. Augenzeugen, [url=http://www.uggkaufen.net/herren-stiefel-wholesale-26.html]Herren Stiefel[/url] , beschrieb die aktuelle Stimmung in Leistung Kammer als "düster", während Davis schien in angeschnallt mit einer Trage gerollt werden. Er oder sie angekündigt, seine Keuschheit muss auch Zeit, innerhalb von 1989 zu töten, wenn Zeugen und auch Familien in den Leidenden - off-duty Savannah, Ga., Polizist Machen MacPhail - sah sich um.

[prada]

ok.trop cool et je reviendrai la prochaine fois.~

[jordan cool grey]

Thanks for sharing. This website is to I too have to help. Very good.

[Walk-in Clinic Laurel]

I think its true that there is shortage of primary care physician or we can that shortage of good primary physician.

[Cliff merchant MD]

The vast majority of doctors do not recommend medicine as a career. The main reason is that malpractice suits that work is not worth it. An opposition to health reform is an important reason assistants.

Could the large number of malpractice suits as a sign that our universities have become up to people who have the ability to be competent doctors? Certainly it takes more than training that takes skill. Or is it a sign that doctors are too quick now days to do a good job?

[moncler sweden]

I also follow through Google Reader!

[Home Security]

I like the train of thought in your post but I tend to think you would do well to back up your thought process with a very small amount more solid data.

[Wholesale Clothing]

My guess? More women going into the GP arena and sensibly dealing with the "long hours and emergency" issues by job sharing and putting to work the same skills used to juggle raising several kids, maintaining a home and perhaps having a job as well.

Immigration is likely to continue to play a strong role as well..... it seems easier to legally get a green card when it's a case of "needed skills" and not displacing existing US employees.

[barbour jacket quilted]

So nice your post, I certainly love this website, come on.

[barbour jacket quilted]

So nice your post, I certainly love this website, come on.

[wedding520]

例えば、プロ結婚式ドレス
のテーラーから裾は非常に基本的な裾のための$ 55の複数の層のための$ 200までの範囲かもしれないが、ウエディングドレス縫製の部屋の周りに自分の道を知っている人にとっては困難な雑用ではないかもしれません。それはすべてのガウンの構造に依存する。裾は非常に単純であるが、あなたのカラードレス 格安
は、裾でのレースがある場合、それはより広範な作業を必要とするかもしれないことに注意することができます。<

[wedding520]

例えば、プロ結婚式ドレス
のテーラーから裾は非常に基本的な裾のための$ 55の複数の層のための$ 200までの範囲かもしれないが、ウエディングドレス縫製の部屋の周りに自分の道を知っている人にとっては困難な雑用ではないかもしれません。それはすべてのガウンの構造に依存する。裾は非常に単純であるが、あなたのカラードレス 格安
は、裾でのレースがある場合、それはより広範な作業を必要とするかもしれないことに注意することができます。<

[Belstaff Coat]

I like the writing structure of your blog and it does a pretty decent job of presenting the material.

[Cheap Scarf Online]

Global demographics instruct that manufacturing job growth in nations with emerging economies will continue to outpace manufacturing job growth in America.

[Cheap Moncler Sale]

Having higher numbers of occupants per existing structure doesn't bode well for selling off the homes having fallen or about to fall into the laps of bankers.All of the sci-fi stories pointed to a shorter work week, more leisure time and industries developing around increased leisure time coupled with the income to enjoy it. We have nothing like that in place or even in mind. Instead those desperate for any kind of job are to work longer hours for less pay and be appreciative for their opportunity.

[Air Force One]

We have nothing like that in place or even in mind. Instead those desperate for any kind of job are to work longer hours for less pay and be appreciative for their opportunity.

[Christian Louboutin UK]

The bitter truth is that the employment prospects for a recent college grad are far more grim, especially full-time employment in their field of study.

[Air Max 2011]

The Occupy Movement and everyone else worried about earnings inequality should be emphasizing the need to find ways to encourage more high school dropouts and high school graduates to get the required background and study habits so that they can, and want to, continue on for a college education.

[Monster Beats Dre]

There‘s always going to be people that hurt you so what you have to do is keep on trusting and just be more careful about who you trust next time around.