With talk about the Affordable Care Act ruling and its effect on the shortage of physicians in this country, a lot of attention has been placed on one type of health care provider in particular – primary care physicians. According to the Association of American Medical College’s Center for Workforce Studies, by 2020, “there will be 45,000 too few primary care physicians in this country”.  And while the AAMC’s report explained that “both an aging U.S. population and greater number of insured drives demand for physician care,” it is also important to point out that medical students aren’t exactly lining up for careers in primary-care medicine.

Let’s face it, working as a health care professional in primary care medicine has not gotten the best rap lately and with the media focusing on why so many medical students are not choosing primary-care medicine, we sometimes forget about why some medical students do choose to practice in the field (and enjoy it). Almost like it would be featured on the show “Dirty Jobs” – it’s a dirty job, somebody’s gotta do it – those considering a career in medicine are constantly bombarded with the negative side of primary-care medicine and unfortunately, early on, many aspiring physicians are turn off from a career as a primary-care doctor. Some common misbeliefs about being a primary-care physicians discourage them from the field, pushing them to pursue other specialties. So, we wanted to shed light on some of the most common misconceptions that surround having a career as a primary care physician.

The Salary Sucks

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Photo credit: flickr by revbean

Lower pay is often cited as one of the most common reasons students choose not to pursue careers in primary-care medicine. While the primary care-specialty income gap has been a concern of many students making decision on which direction to take their career, there is light at the end of the tunnel. A recent report published by the Medical Group Management Association (MGMA) reveals that new methods for paying primary-care physicians may soon help increase their pay. According to the group’s report, the average earnings for primary-care physicians increased around 5.2%, which translates to a faster jump than those of specialists. “There appears to be a growing focus on primary-care providers in anticipation of new methodologies in payment, a focus on coordination of care, and the imperative to control utilization and costs in the system,” Dr. Michael Nochomovitz, president of University Hospitals Physician Services in Cleveland, said in an MGMA news release. “There is increasing employment of physicians by integrated delivery systems and hospitals, which may also explain these shifts in compensation for primary-care physicians.” Nowadays, primary-care physicians are being offered attractive hiring incentives. According to the same MGMA salary report, slightly more primary-care physicians than specialty care physicians reported receiving a signing bonus in their contract. Moreover, according to the Fact Sheet: Creating Jobs and Increasing the Number of Primary Care Providers, a few provisions are in place to encourage and educate more physicians to practice in primary care, including:

  1. Expanding tax benefits to health professionals working in underserved areas: In addition to the incentives provided by the Department of Labor and Education to pursue primary care as a profession, the Department of Treasury is responsible for providing tax benefits to students. The Affordable Care Act includes a provision that excludes from taxes the value of student loans that were repaid or forgiven because the individual worked in certain health professions, including primary care.
  2. Building primary care capacity through Medicare and Medicaid: Medicare will provide a 10 percent bonus payment for primary care provided by qualified physicians from 2011-2015. In addition, Medicaid payment rates to primary care physicians will be increased in 2013 and 2014 to at least 100 percent of associated Medicare rates.
  3. Making health care education more accessible: Many individuals in health professions are eligible for generous student loan forgiveness programs under current Department Education programs. This includes Public Sector Loan Forgiveness, which allows individuals in eligible jobs to have their loans forgiven after 10 years. The Affordable Care Act expands the existing income-based student loan repayment program for new borrowers after July 1, 2014, by capping payments at 10 percent of their discretionary income (down from 15 percent) and forgiving loans after 20 years (down from 25 years). Public sector employees will still have their loans forgiven after 10 years.

So while primary-care physicians may not make as much as their colleagues in higher-paying specialties, there are a number of incentives in place now – and set to be put in place in the future – that have the potential to make salary more of a non-factor when medical students are deciding on pursuing the field or not.

A Work-Life Balance Doesn’t Exist.

Now more than ever, to attract and increase their primary-care workforce, employers are giving significant attention to work-life balance and advertising their primary care openings as those that offer flexible scheduling in order to help physicians achieve a work-life balance.

Due to required work hours and patient care duties, many students believe that practicing as a primary-care physician is pretty much a death sentence for their personal lives. And while the factors influencing medical students’ career choices were once unclear, studies have now shown that this is indeed the belief. In 2008, a study published in the Journal of the American Medical Association found that graduating students had serious reservations about the quality of life and rewards of the field compared with other specialties. For students who wish to go into primary-care medicine and rank quality of life high on their list of priorities, there is a way to have both. Now more than ever, to attract and increase their primary-care workforce, employers are giving significant attention to work-life balance and advertising their primary care openings as those that offer flexible scheduling in order to help physicians achieve a work-life balance. According to an article posted on the American Medical Association’s Web site, recruiters are now offering great incentives to attract physicians including, flexible work schedules and shorter workweeks.  For example, in an job advertisement seeking a primary-care physician, the Veterans Health Administration says most of their professionals enjoy a Monday thru Friday from 8-4pm schedule with little to no on-call expectations. And this is not the only place making such offers – hundreds of employers across the country are answering demands from primary-care physicians who are seeking the same perks and benefits their colleagues receive in other specialties.

The Administrative Burden is Crazy!

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Photo credit: flickr by Thirteen of Clubs

Ask any doctor, primary-care or not, about an aspect of their job that they are less enthused about and the answer will most likely be unanimous – paperwork. One study revealed that physicians reported spending almost a half hour each day, three hours each week, and three weeks per month interacting with health plans aka being consumed with paperwork. Furthermore, primary care physicians spend significantly more time (3.5 hours weekly) than other medical specialists (2.6 hours) or surgical specialists (2.1 hours). Fortunately, however, many have taken notice of the challenge these physicians face as they battle with completing paperwork and spending time with their patients. The change may come by way of an Affordable Care Act provision that is designed to “cut red tape in the health care system.” According to a press release issued by the U.S. Department of Health & Human Services, the new rule – which involves getting rid of the inefficient manual process associated with paperwork and bringing in the use of electronic system – will not only save health care providers and health insurance companies money, but also allow physician offices to redirect time now spent on administrative tasks to patient care. “This is only the beginning of our efforts to cut out waste and inefficiency in our health care system and free dedicated doctors, nurses, and caregivers to focus their time and efforts on keeping patients healthy, treating illness, and restoring health.”

This article was published in the November/December 2012 issue of PreMedLife magazine.