Northeast Indiana health care faces a looming problem as production of primary care providers isn’t keeping up with growing demands for medical services.
While the patient population has grown over the years, the number of new primary care physicians – those in areas like family practice and internal medicine – slowed over the past several years.
“One of the biggest problems is we’re not producing enough doctors going to the right places,” said Dr. Zachry Waterson, program director at Fort Wayne Medical Education Program.
Demand for physicians is expected to increase by 17 percent and outpace supply by 2025, the Association of American Medical Colleges reported earlier this year. The group, citing an economic forecasting study, anticipates a shortfall of 12,500-31,100 primary care doctors in the next decade.
The previous decade saw declines in medical students pursuing careers in primary care as they saw the average salary – now at about $195,000 per year – wasn’t much above the education debt they incur, which reached about $170,000 in 2012. Such doctors were also overworked with higher levels of stress and unhappiness.
Jobs in sub-specialty fields, like cardiology, hematology/oncology and neurosurgery, provided more lucrative pay, a 2012 review from physician search and consulting firm Merritt Hawkins shows.
Most graduating medical residents veered away from careers in general internal medicine, including primary care fields from 2009-2011. About 64 percent of those surveyed by the Journal of the American Medical Association in 2012 favored positions in sub-specialty areas, compared to nearly 22 percent who intended to pursue internal medicine careers.
But the numbers started slowly turning around a few years ago. Provisions in the Affordable Care Act and the American Recovery and Reinvestment Act provided more funding for training and debt relief in order to encourage renewed interest in primary care careers, according to an article from the American Medical Association’s Journal of Ethics.
“There’s been a significant increase in the number of medical school students,” Waterson said.
Graduates from the Indiana University School of Medicine on the Indiana University-Purdue University Fort Wayne campus tend to disperse to various fields, said Gina Bailey, assistant director of program development. The 12 students in the previous cohort, pursued openings in primary care, emergency room care and surgical sub-specialties, among others.
While medical school enrollment is up, graduates nationwide are hitting a logjam getting into residency programs.
“It’s becoming more difficult for every student to find a spot regardless of what area they go into,” Bailey said.
A big part of the problem is residencies haven’t expanded with the med schools.
“The number of residency slots has remained relatively unchanged,” Waterson said.
Hospitals stopped expanding the training positions in the late 1990s when the government limited funding for new slots to help balance the federal budget, he said.
Hospitals would have to pay out-of-pocket to increase residency openings, which could be cost prohibitive.
“We’re talking about huge amounts of money,” he said.
Primary is not first choice
About 10 residents enter a three-year training each year through Fort Wayne Medical Education. The program, as the only residency program in the city, focuses primarily on family care and rotates residents through hospitals in the Parkview Health and Lutheran Health Network systems, as well as hospitals throughout the region.
About two-thirds of those who completed their residencies during the past five years have taken positions in northeast Indiana, he said.
Nationally this year, 39 percent of all U.S. medical school seniors, or about 6,600, matched into first-year residency programs in the categorical primary specialties of family medicine, internal medicine and pediatrics, according to the National Resident Matching Program.
Most seniors seemed to balk at family care and internal medicine. Of those matched to family medicine, 44 percent filled the offered positions, while 49 percent of seniors matched to internal medicine filled the offered positions there.On the other hand, nearly 71 percent of the seniors matched to pediatrics took the positions.
All of the offered residency positions in obstetrics-gynecology, meanwhile, were filled, with about eight out of 10 of the spots taken by medical school graduates, the highest since 1999, the NRMP said.