People who regularly see primary care physicians tend to live longer and healthier lives – if they can locate and secure doctors near home, Michigan doctors said.
Despite the necessity of such practitioners, who handle patients from birth to death, from newborns to grandparents, there are too few of them and trends suggest there will be even fewer as current practitioners age and medical students with six-figure loan debts chose more lucrative specialties.
Nearly 3 million people live in parts of the state with an inadequate population-to-provider ratio, according to the Kaiser Family Foundation, which cited 2021 data from the US Health Resources and Services Administration. The problems are especially strong in rural regions and urban centers.
“If we don’t address the shortage that we are experiencing here in Michigan, it’s going to get worse,” Dr. Jennifer Aloff, a Midland family physician who works in private practice, told reporters Monday, March 21, the start of what has been deemed “Family Medicine Week.”
The consequences include negative health effects, increased health care costs and reduced access to care, said Dr. Srikar Reddy of Ascension Medical Group in South Lyon and president of the Michigan Academy of Family Physicians.
It is primary care doctors who are building connections and helping people make decisions, he said. “That relationship, that sense of trust, that sense of outreach is priceless. And it comes down to the core of who we are as family docs.”
Of Michigan’s 83 counties, 75 are at least partially designated as having shortages. The state now needs 482 practitioners to remove the shortage area designations, according to the family foundation.
By 2030, the state will be short 860 primary care physicians, the Michigan Academy of Family Physicians reported on Monday. This was a projection published by the American Academy of Family Physicians’s Robert Graham Center and based on Michigan’s population and the number of primary care physicians in practice in 2010.
According to a 2019-2020 workforce profile published by the Association of American Medical Colleges, there are about 10,200 primary care physicians in Michigan. They made up about 34% of more than 30,000 total active physicians. The goal is 40% or more, Aloff said.
To address the situation, the state academy is calling on state leaders to invest an additional $31.4 million in existing programs, MIDOCS and the Michigan State Loan Repayment Program.
“Primary care saves costs. Investments are going to go a long way toward addressing this crisis and leading us toward a better family health care future,” Reddy said.
MIDOCS, funded by the state, increases the number of medical residency training slots in primary care and other high-need specialties. Those accepted must commit to two years of practice in a rural or urban underserved area after they complete their residencies. In exchange, they may receive up to $75,000 for repayment of eligible educational loans.
The program partners with the medical schools at four state universities: Central Michigan, Michigan State, Wayne State and Western Michigan.
Since the 2017 fiscal year, the state appropriated $15.1 million to the program. This, combined with university and federal contributions, has created 52 new residency slots, according to the 2021 program report.
The loan repayment program assists employers in recruiting and retaining primary care physicians by helping to reduce their educational debt. It provides up to $200,000 in tax-free funds to repay debts for those who demonstrate commitment to building primary care practices in underserved communities by working 40 hours a week and at least 45 weeks a year at eligible nonprofit practice sites.
Now, about 40% of applicants receive awards, demonstrating demand for expansion, the state academy of family physicians reported. In her budget proposal for the 2023 fiscal year, Gov. Gretchen Whitmer proposed $25 million to include mental health professionals, another specialty experiencing shortages.
Whitmer’s office did not respond to a request for comment on Monday.
There are various reasons people might choose other specialties, doctors said.
Economics play a large part; primary care physicians are paid less than other specialists, said Dr. David Lick, program director, vice chair of education and professor with the Department of Family Medicine at the Oakland University William Beaumont School of Medicine.
Some doctors leave school with large education debts – the average medical school graduate owes about $242,000, reported the Education Data Initiative, a group of researchers.
“People that go to medical school do the math. They can figure it out pretty easily,” Lick said.
Family medicine doctors in the United States earn an annual mean wage of about $220,000 in physicians’ offices, according to the US Bureau of Labor and Statistics. An anesthesiologist, for example, makes about $283,000. A surgeon has a mean wage of about $268,000 and an obstetrician and gynecologist makes about $247,000.
Reddy said there needs to be a grassroots move toward focusing on preventative care, to mitigating the need for acute and emergency services. “And I think if we shift our focus, I really feel that that shift will also happen economically.”
Additionally, the job requires documentation, quality measures and other obligations people did not consider when they decided to go to medical school, Lick said.
Aloff noted metrics tracking can fall on primary care doctors. These records have “value downstream,” such as ensuring patients’ hypertension is adequately controlled, but can also involve “a lot of extra work.”
She said a private practice is a small business and it can be a struggle with increasing overhead costs and fixed rates of payment from insurance companies.
Contributing to worsening shortages is the age of the workforce.
dr Michael Bishop, program director of family medicine residency at Mercy Health Grand Rapids Medical Education, said two of every five primary doctors will be 65 in the next 10 years.
Meanwhile only about 27% of new medical school graduates now enter the primary care workforce each year, Bishop said.
Many leave Michigan, sometimes returning to their home states after traveling for school, which speaks highly of the schools’ reputations, Bishop said, but does not address shortages.
The MIDOC program helps because residents often work where or near where they’ve done their training. “So we can residents exposure to those communities and hopefully drive them to see the need there and want to practice there,” Aloff said.
Most who choose primary care had a positive mentorship experience as students or residents, she said.
When she first began her career 20 years ago, she used to look at her schedule and say: “What do I get to do today?”
Now, she looks at her agenda and says: “Who do I get to see today?”
“And that’s really what it’s about in primary care is knowing our patients, knowing their families, building those long-term relationships and going on that health journey with our patients.”
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