MMA Viewpoint
How Can We Attract the Best and Brightest?
Recently, I was reading about the factors that lead to the demise of businesses or industries, and how to tell whether a particular profession is at risk.
One of the examples cited was the decline of the railroads. In the late 1800s and early 1900s, the best and brightest students went into railroad work. But after World War I, railroads were perceived as dying institutions, and the best and brightest were no longer attracted to them.
That made me think of our own profession. Will medicine continue to attract the best and brightest? Economic and professional forces are at work today that could make other fields more attractive.
As I talk with high school students in my practice, it doesn’t seem as if as many of them are interested in medicine as students were several years ago. They are discouraged by the expense of a medical education and the long time it takes to go through school and residency.
The average student debt upon graduation from the University of Minnesota Medical School is more than $140,000. This not only discourages some from choosing a career as a doctor, but it also influences some medical students’ choice of specialty. For the past six years, there has been a steady drop in the number of fourth-year medical students in the state choosing primary care residencies.
Part of the reason is lower reimbursement for primary care than for other specialties. In 2007, the median salary for family physicians was $185,730, lagging well behind earnings for nonprimary care doctors. For example, the median salary for orthopedic surgeons was $435,000 and that for cardiologists ranged from $389,243 to $435,000.
Another factor is the pressure to rush through patient visits. Our current reimbursement system rewards physicians for patient visits and procedures rather than for providing comprehensive care and forming a long-term relationship with their patients.
We hope that the medical home model that the MMA and others are promoting as part of health care reform will help make primary care more attractive again. The reimbursement structure will encourage physicians to spend time preventing disease and managing care, especially for those with chronic illnesses.
We need to turn around the perception that primary care is not a good choice. We have a looming shortage of primary care physicians, especially in certain urban and rural communities in Minnesota.
For many young people, lifestyle factors affect their choice of profession or specialty, and may be even more important than salary. Today, half of medical students are women, and there are many two-physician families with children.
Many young physicians express concern about life balance. In a survey asking physicians younger than 50 to rate their lifestyle, 71 percent indicated that time for family and personal time were very important; only 42 percent rated long-term income as being important.
Medicine is changing, and the expectations of students are changing. To stay competitive, we have to pay attention to what’s happening.
I believe that medicine has a promising future. Our health care reform efforts may help determine whether we continue to attract the best and brightest or become like the railroads of a hundred years ago. We all need to assure our young people that medicine is a wonderful profession that offers deep satisfaction. The best and brightest are looking to us for leadership. Please devote energy to finding your replacements.