IN HIS REMARKS to the National Academy of Sciences annual meeting yesterday, President Obama said "the greatest advances in medicine have come from scientific breakthroughs, whether the discovery of antibiotics, or improved public health practices, vaccines for smallpox and polio and many other infectious diseases, antiretroviral drugs that can return AIDS patients to productive lives, pills that can control certain types of blood cancers, so many others."
The next great breakthrough, with great irony, will be finding the doctors to advance the advances.
Obama has put science back on a pedestal after eight years of it being submerged by the Bush administration. A key test of connecting this to the people is whether the administration can resuscitate primary care into a prime career. Many newspapers have documented the dwindling of internal medicine and family-medicine doctors. The Massachusetts Medical Society last year said that those two specialties "face critically stressed labor markets" in this state. The society found that the percentage of family medicine physicians who no longer accept new patients rose from 25 percent to 35 percent between 2006 and 2008, and the percentage of internal medicine doctors who no longer accept new patients went up from 31 percent to 48 percent.
This month, the society published another report that found that the costs of maintaining a practice and the crush of trying to see more patients in less time have resulted in Massachusetts being no different from the rest of the nation in struggling to keep the physician pipeline flowing. Despite being a global mecca for medical students, the percentage of physicians in Massachusetts who are 55 and older rose from 30.5 percent in 1992 to 41.1 percent in 2008. That is similar to a national aging of physicians 55 and over from 34 percent in 1992 to 44 percent last year. Only 13 percent of physicians currently practicing in Massachusetts are under 35.
In Senate testimony last year, Bruce Auerbach, president of the Massachusetts Medical Society, pleaded for stronger federal funding designed to boost the number of primary-care doctors, particularly those doctors who want to work in underserved areas.
"Without a sound financial model that incents quality care and a robust physician workforce, our efforts to improve access to healthcare and to reduce costs will fail," Auerbach said.
Obama is aware of the problem. "We’re not producing enough primary-care physicians, because the costs of medical education are so high that people feel they’ve got to specialize," he told a healthcare forum last month.
Similarly, he said of the parallel nursing shortage in the United States, "it’s not that complicated . . . they don’t get paid very well . . . the notion that we would have to import nurses makes absolutely no sense."
In trying to make sense out of this, Obama yesterday announced the formation of a science and technology advisory council that includes medical specialists such as Christine Cassel, president of the American Board of Internal Medicine. Cassel last year cowrote a letter to The New York Times that said, "The fact that so many medical students are choosing lucrative specialties like dermatology over internal medicine should be a clarion call that our healthcare system needs an overhaul. It is unfortunate that a doctor can earn $2,000 an hour performing a cosmetic procedure while a primary-care physician earns far less preventing and treating life-threatening diseases like diabetes and hypertension. Payment disparities like this have turned our nation’s healthcare upside down."
It is so upside down in her own area of geriatrics, Cassel told a House committee earlier this month, that most geriatricians who are in private practice are "wasting all that training doing Botox" and laser skin surfacing while "nobody pays them" to keep patients out of hospitals and nursing homes.
The richest nation in the world may be 124,000 physicians short of a needed 859,300 by 2025, according to the Association of American Medical Colleges. Cassel said the quality of healthcare "rests in great part on the skills and judgment of the physician in relationship with the patient." Obama is in an unprecedented race to find the doctors to restore the relationship.
Derrick Z. Jackson can be reached at jackson@globe.com.
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