Sunday, December 28, 2008

I Think the Tide is Turning

It would take a lot for me to go back into outpatient medicne.  More than I think the beancounters are willing to concede.  Nonetheless, in the short time since I opted out of Primary Care, I sense a change in the national discourse.  I am hearing less and less about the problem of the uninsured, and more and more about the pending disaster of those-with-insurance-with-nowhere-to-go.  While most of the information in this article is not new to most of us, it does highlight that the crisis is growing if a major metropolitan area is starting to worry.

Rural communities have had trouble keeping doctors since before I went to medical school.  But the pool of primary care physicians has shrunk enough that larger and larger rural communities have begun to feel the pinch.  I would venture to say that the new generation of physicians wants to live near more "stuff" than previous ones.  Just look at residency programs.  

Program directors of most internal medicine, pediatric and family practice programs have known for some time that recruitment to the Midwest (even to major cities) is inherently harder than places with 320 days of sunshine, oceans or mountains.  If you're going to work 120 hours a week for less pay than a tenured grocery store cashier, you might pick the hospital in paradise versus the one in the frozen tundra.

This is why I think that the loudest cries are going to start coming from the larger cities in the nation's midsection.  I'm not seeing a lot of Locum Tenens agencies begging for help in Manhattan or San Francisco.  
It's going to be a while before there aren't physicians willing to work for the CMS pittance in exchange for a 1-bedroom rental in a cultural epicenter.  But when we've reached the day when an above average primary care physician salary can't attract anyone to a smaller city with imperfect weather, but major sports teams, an art museum, a symphony, an international airport, and premium shopping... maybe that salary isn't so above average...

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