If the Affordable Care Act works like it’s supposed to, 32 million Americans will obtain health insurance for the first time over the course of this decade. Authors of the health reform law expect primary care physicians (PCPs) to care for most of these people. Unfortunately, the nation’s severe and worsening PCP shortage means these expectations are unrealistic.
How big is the PCP manpower problem? The Association of American Medical Colleges estimated we’d be short 45,000 of ’em by the end of this decade, and that was before the Big O signed the Affordable Care Act into law.
Many studies have linked the dwindling supply of PCPs to long work-hours, administrative hassles and most importantly, a widening income gap between PCPs and specialists.
A recent study by Martin Palmeri and colleagues at Dartmouth has shed light on one aspect of this income gap: the excessive debt burden faced by PCPs in the first years after they complete residency training.
To quantify the early-career financial situation for PCPs, Palmeri’s group developed a net income and expense model based on data from the 2007 Physician Compensation Survey and several other databases. Their model looked at physician reimbursement, medical student debt, college savings, retirement planning and cost-of-living expenses.
The scientists found that in contrast to specialists, most PCPs do not earn enough in the first 3 to 5 years post-residency to cover expenses.
PCPs who deferred loan payments until after residency averaged $199,159 in debt, the scientists found. To pay this off in 10 years, they had to fork-out monthly payments of $2,261. When their debt repayment was combined with housing costs, retirement savings, children’s college savings and other expenses, PCPs ended-up $801 short each month, assuming their average starting salary was $130,000. This doesn’t even include the costs of entertainment, clothing and travel expenses.
In the researchers’ model, the only way PCPs ended-up with a net positive income in the first 3-5 years after residency was if they had no debt coming out of medical school or exhibited a lifestyle considered by the researchers to be “optimal low cost” (Mad Men reruns on a Saturday night, anyone?).
The sliver of good news in the study was that PCP income did rise quickly during those first few years, but the scientists were unequivocal in their conclusion: the short-term financial realities faced by primary care physicians create strong disincentives to the pursuit of a career in that field.
Palmeri himself is training to be an Oncologist, by the way. His study appears in the November issue of Academic Medicine.