Do the Math: Hiring More Primary Care Doctors Adds Many Benefits

\r\nHe has published in several medical journals, including recent research on use disparities in telehealth visits & effective community outreach interventions to encourage COVID vaccination. His weekly MedPage Today column, \u201cBuilding the Patient-Centered Medical Home,\u201d focuses on improving patient care.<\/p>“,”affiliation”:””,”credential”:”MD”,”url_identifier”:”fp4223″,”avatar_url”:”https:\/\/assets.medpagetoday.net\/media\/images\/author\/Pelzman_330px.png”,”avatar_alt_text”:”Fred Pelzman”,”twitter”:””,”links”:null,”has_author_page”:1,”byline”:”Contributing Writer, MedPage Today”,”full_name”:”Fred Pelzman”,”title”:”Contributing Writer, MedPage Today, “,”url”:”https:\/\/www.medpagetoday.com\/people\/fp4223\/fred-pelzman”,”bluesky”:””}]”/>

How much does it cost to hire a new physician? And how much do we gain?

As the academic year moves towards its inexorable end, things are shaking up. Senior residents around the country are starting to look for jobs. People are thinking about moving from one city to another.

And we step again into that delicate dance of figuring out when to hire, how many to hire, who to hire. There’s always complex math involved — who is retiring this year? Who needs to cut back on their clinical sessions to 50%? Who wants to change from one practice site to another? Who wants to go concierge? Where are the opportunities for growth?

Over the past several months, we have been getting a bunch of resumes from senior residents and those completing fellowships who are looking to start a new job. Sometimes I wish we could just hire them all.

These days it feels like there aren’t that many residents, even among the cohort of our primary care track residents, who are anxious to take on clinician educator jobs at academic medical centers, serving a broad swath of society in a challenging setting.

There’s lots more interest in private practices, concierge medicine, urgent care or shift work, telehealth practices, and other shared practice models.

But fewer and fewer young physicians seem to want to be doing this kind of job, teaching medical students and residents part of the time, seeing your own patients, developing academic careers and exploring leadership roles within the institution, putting a toe in the research waters, and more.

Those of us who do this think the opportunities are amazing and endless and totally worth doing readily acknowledge that sometimes it can be a hard sell, as evidenced by the extreme shortage of primary care doctors out there in the world. We’ve all seen the reports estimating the tens of thousands (if not more) of primary care doctors that our nation will need over the coming years, as our population ages and more people step away from old-fashioned outpatient primary care.

Already we are swamped. We are turning away new patients every day, sometimes hundreds a week — people who had to change insurance and lost their primary care provider or who moved from another city and need a new doctor. And far too often we hear that common lament, “My doctor no longer takes Medicare; you’re the only one in my network who had any availability.”

As our population ages and medical care and the practice of medicine get more complex, and as the demand on us to see more and more patients increases, it would be really great if we could bulk up our primary care workforce, solidify that foundation of the healthcare system in this country that we obviously so desperately need.

Sure, hiring a new doctor costs money. Whoever’s doing the hiring has to lay out their salary, benefits, and fringe and insurance costs before they start to make a dime. Getting them enrolled in every insurance plan, signed up and trained on every system we use, getting them certified and licensed, takes an enormous amount of administrative support, which costs money. And of course, they need an office and exam rooms, a share of support staff, gowns, gloves, and those really nice rolls of white paper that drape over the exam tables.

But the returns surely outweigh these costs. If you were out there in the world, and you needed a doctor, wouldn’t it be great to be met with the response from every practice you called, “Yes, we have a wonderful new doctor who can see you this week.”

And think of all the good they can do. I know that primary care doctors can’t bill as well as a surgeon, a subspecialist, or a proceduralist. Brain surgery or transplant is going to make the hospital a lot more money than we are, no matter how many patients they shove onto our schedule. But there are many intangible benefits that we ought to consider as well. (And maybe, someday, those who decide whom to hire will take those intangibles into account and raise the baseline primary care physician salary, thus attracting more candidates to this job.)

Forming long-term relationships with patients, getting them to trust the healthcare system, becoming advocates for all our patients as they navigate the ups and downs of their health in challenging times, is priceless. Vaccinating a patient to prevent a catastrophic illness later: priceless. Screening for cancers to prevent devastating complications and even loss of life by finding something early enough to be successfully treated: priceless. Controlling chronic diseases, managing acute illnesses to keep people out of the emergency room where more expensive care is provided, and avoiding complications by controlling diabetes, heart disease, and asthma: all priceless.

Not to mention that these are the teachers of tomorrow, the folks who are going to be training the next generation of doctors to take care of us all as we get older, as well as our children and grandchildren. And this doesn’t even begin to count the downstream benefits, the subspecialists we refer to, the radiology imaging we order, the blood tests we do in the lab, and the surgeries our patients need.

So, when we tell the powers that be that we would really love to hire a bunch more doctors, increase the number of clinical full-time employees we have seeing patients, give us more space, give us more support personnel, help us manage the in-basket and lessen burnout, and create access for our subspecialty patients who have needs, maybe they can listen.

Maybe they can do the math.

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