Key Points
- Report says family practice specialty on its way to extinction.
- Survey shows few medical students plan to be general internists.
- Locum tenens offers positive alternative to primary care physicians.
Tim Boes
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Primary care practice is ailing, and it is anybody's guess what might restore it to health. The signs warning of primary care's
decline have been apparent for some time. In 2004, the American Academy of Family Physicians (AAFP) released a report concluding
that unless major changes are made to compensation and work conditions, family practice may not exist as a specialty in 20
years. In 2007, 16% of available family practice resident slots went unfilled, and more than half of the slots taken were
filled by international medical graduates. It seems that family practice is another one of those jobs Americans simply won't
do anymore.
Things are no more encouraging in internal medicine. The Journal of the American Medical Association published a survey late last year indicating that only 2% of medical students intend to go into general internal medicine
when they graduate.
What is so wrong with primary care that physicians are no longer attracted to it? To find out, Merritt Hawkins & Associates
recently conducted a survey in which approximately 12,000 physicians participated (like Staff Care, Merritt Hawkins & Associates
is a division of AMN Healthcare). The survey was conducted on behalf of The Physicians' Foundation, a group of physician and
state medical society leaders committed to physician advocacy. The majority of physicians who responded to the survey (approximately
9,000) are in primary care, defined as family practice, general internal medicine, pediatrics, and obstetrics/gynecology (see
http://www.physiciansfoundation.org/ to view complete survey data).
Although survey results paint a generally pessimistic picture of physician morale, they do help explain why physicians are
choosing locum tenens as a practice style and suggest that even more doctors will do so in the future. Forty percent of physicians surveyed described the morale of doctors today as "poor" or "very low," while only 6% described
physician morale as "positive." Only 17% of physicians said their practices are "healthy and profitable." Ninety-four percent
said the time they devote to nonclinical paperwork has increased in the past 3 years, and 63% said that nonclinical paperwork
has caused them to spend less time with patients.
When asked what aspects of medicine they find unsatisfying, "reimbursement," "managed care issues," and "malpractice/defensive
medicine" topped physicians' lists. About half of those surveyed indicated they will take steps in the next 1 to 3 years that
will either take them out of patient care or reduce the number of patients they see. Some said they will retire, some said
they will seek nonclinical jobs, and some said they will work part-time.
Which brings us to locum tenens. Many of the concerns physicians have with current practice conditions—administrative paperwork,
climbing practice costs coupled with flat reimbursement, high malpractice rates, inability to focus on patient care—are minimized
or eliminated by locum tenens. It is interesting to note that 7.5% of physicians said they plan to work locum tenens in the
next 1 to 3 years. People do not always do what they say they are going to do in surveys, but let us suppose 7.5% of the approximately
800,000 active physicians in the United States choose to work locum tenens in the next 36 months. That would be close to 48,000
physicians. Even half that number would be a huge addition to the locum tenens workforce.
The good news is that those physicians who choose to work locum tenens will still be in the workforce treating patients and
contributing to overall access to quality care. They will not be retired, in a nonclinical setting, or otherwise removed from
patient care. While locum tenens cannot by itself rekindle physician interest in primary care or in medicine in general, it
does play a part in maintaining the physician workforce by keeping physicians "in the game." So while the skies may be gray
in primary care, locum tenens offers a silver lining.
An overwhelming majority of physicians—78%—believe there is a shortage of primary care doctors in the United States today.
Source: The Physicians' Foundation (Oct. 2008). "The Physicians' Perspective: Medical Practice in 2008."
