Where are our Family Doctors? One Alternative Solution to the Shortage

| April 9, 2013 | 0 Comments

This past January, I shadowed Dr. Robert Fields, an internal medicine physician whose practice differed in significant ways from the norm.  His is a practice that belongs neither in the category of standard private practice in the current insurance system nor “concierge medicine,” which implies selectivity in caring for wealthier patients.  Dr. Fields gives unhurried care to his patients, with checkups that are over an hour long, a personalized to-do list to empower patients to take educated care of their health, and same-day sick visits, among other perks of old-fashioned quality care. He does not accept insurance at all; he only asks for a modest one-time annual fee both reasonable and affordable for the blue-collar worker[1].

Dr. Fields modified his practice in this manner so that he could take better, unhurried care of his patients rather than have patients wait their turn to receive a rushed, quick consultation with him.  Effectively, this is a response to the issues that internal medicine physicians typically face on a daily basis.  Medical students have complained about these issues, which include rushed checkups, dealing with insurance companies, more paperwork, facility with a greater breadth of knowledge, and lower pay than specialties[2].  These characteristics of the career today perhaps makes the career less appealing, and contributes to the current shortage of internal medicine physicians.

The shortage of internal medicine physicians in the United States and abroad is increasing.  In the US, a recent study found that a far greater number of residents in primary care and categorical programs planned on pursuing subspecialty career plans over general internal medicine.  The proportions are tens percentages apart; around 40% of primary care and 20% of categorical residents report plans of pursuing careers in general internal medicine, while around 50% of primary care and 65% of categorical residents reported plans of careers in subspecialties[3].  The shortage is a global one; the 2006 Global Health Report estimated a global shortage of 4.3 million physicians, nurses and other health workers[4]. The general implication of this shortage in primary-care physicians is that we lose those doctors who take the first steps in diagnosing illnesses, guide us on chronic diseases, and help us take preventive measures against new diseases[5].

Outside of the current health care system, there exists a seemingly sustainable solution.  Dr. Field’s current lifestyle and profession attests to the possibility of saving the profession of general internal medicine by removing what generally characterizes it – longer hours, insurance paperwork, and rushed appointments.  In addition, the yearly fee can be customized by the physician according to his preferences.  In order to give quality care to his patients, Dr. Fields keeps his list of patients around 400, which made me wonder if this turnover might just contribute to the shortage since the patient list is limited.  However, Dr. Fields reassured me that although this method might create shortage in the immediate short-term, in the long term, it saves the face of internal medicine by making the field more appealing to medical students[6].

[1] “The Patient-Centered Medical Home,” Robert P. Fields, MD., accessed April 1, 2013, http://www.drfields.net/aboutourpractice/thepatientcenteredmedicalhome.html.

[2] National College of Physicians, “Critical Shortage of Internal Medicine Physicians Foreseen,” Journal of Medicine, July 15, 2012, accessed April 1, 2013, http://www.ncnp.org/journal-of-medicine/1092-critical-shortage-of-internal-medicine-physicians-foreseen.html.  

[3] Colin P. West et al., “General Medicine vs Subspecialty Career Plans Among Internal Medicine Residents,” The Journal of the American Medical Association 308 (2012): 2241-2247.

[4] World Health Organization, “The World Health Report 2006,” Geneva, Switzerland, 2005.

[5] Pauline W. Chen, December 20, 2012, “Where Have All the Primary Care Doctors Gone?” New York Times Doctor and Patient Blog, http://well.blogs.nytimes.com/2012/12/20/where-have-all-the-primary-care-doctors-gone/.

[6] Dr. Robert P. Fields, MD., direct question to physician, January 11, 2013.

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