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Record med school enrolls, but numbers will barely put a dent on country's needs

By Bill Toland

Pittsburgh Post-Gazette

Published: Saturday, Nov. 9 2013 1:45 p.m. MST

For those concerned about the predicted national shortage of primary care physicians, here's the good news: U.S. medical school enrollments hit a record high this year, topping 20,000 first-year students for the first time this autumn, according to numbers released last month by the Association of American Medical Colleges.

Associated Press

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PITTSBURGH — For those concerned about the predicted national shortage of primary care physicians, here's the good news: U.S. medical school enrollments hit a record high this year, topping 20,000 first-year students for the first time this autumn, according to numbers released last month by the Association of American Medical Colleges.

And some more good news: Of the 16,000 medical school students entering residency, 6,327 bypassed medical or surgical specialty tracks and chose to continue their training in internal medicine, family medicine or pediatrics, which is an increase from 2012.

"We're definitely going to need them," said Amelia Pare, a McMurray plastic surgeon and head of the Allegheny County Medical Society.

That need for family doctors is driven by a graying population of both doctors and patients and by an influx of millions of new patients via the Affordable Care Act's Medicaid expansion and its mandate that everyone without health insurance obtain it or face fines.

The bad news: 20,000 newly minted MDs will barely put a dent in the current doctor shortfall, let alone the even bigger shortage predicted for the coming decade, with perhaps 150,000 doctors needed overall, 50,000 of them being primary care physicians. Meanwhile, nearly half the nation's physicians are older than 50.

"It is encouraging that medical schools are seeing continued increased enrollment overall," said Reid Blackwelder, president of the American Academy of Family Physicians. "We're hopeful those medical students will indeed want to go into (primary) medical care."

Problem is, most won't — less than 25 percent of new doctors go into primary care. And those 6,327 who this summer chose to pursue family medicine, internal medicine or pediatrics? Many eventually will select a sub-specialty, effectively removing them from the ranks of general practitioners.

They do so for obvious reasons — a family doctor in the U.S. makes one-half or even one-third of what many specialists make. "It's just not as lucrative as other specialties are," Dr. Pare said. And doctors often have hundreds of thousands of dollars in student debt to repay.

It's a recipe for a systemic crash, barring major changes in the way this country trains doctors and delivers health care, according to Candice Chen, a pediatrician and a researcher at George Washington University School of Public Health and Health Services.

A 'BROKEN' SYSTEM

The way the U.S. trains doctors, by and large, is through medical schools attached to hospital systems. This means that new doctors, once they complete their residencies, are more likely to have experience working in a hospital operating room than in a rural primary care clinic.

"The result is that we get a workforce that is ready to staff the hospitals of America, rather than the entire health care system," Dr. Chen said.

Hospitals need more specialists than they do primary care doctors, by a 4-1 ratio. So when they expand residency programs, they often do so with an eye toward specialty staffing needs and not primary care residencies.

Hospitals say they could train more primary care physicians if Congress would send more money. Right now, most of America's residency programs are subsidized by Medicare funding. Other pots of money are available — Medicaid, the Veterans Affairs system, children's hospital allocations and medical schools are welcome to fully pay for their own residency slots — but the bulk of the money for training doctors at the graduate level comes from Medicare's annual $10 billion allocation.

Medicare hasn't increased the number of residency positions that it funds since 1997, locking its number of sponsored slots at 1996 levels, which amounts to about 91,000 students in residency training at any given time.

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