Count on physicians starting out to have both a keen dedication to clinical care and an equally keen commitment to honoring outside interests. One way they achieve this is by opting for nontraditional schedules, says Mosley. “As newer docs come in, working part-time when others retire, there’s not a one-to-one replacement.”

Another factor is that the majority of new physicians (53 percent) are women. Many of them have a different outlook on work than do their male counterparts, says McCartie. “They’ll be 27 or 28 years old” when they graduate medical school, he says. It’s a prime time to start a family. “The female is still the nurturer,” says McCartie. “No matter if they’re a vascular surgeon, when their kid has soccer or is sick, he wants his mother.”

This may strike some as politically incorrect. But the point must be acknowledged. Moreover, the influx of women into the field, including those who choose to work part time, could drive positive change for primary care. The law of supply and demand always prevails, and it will change how employers attempt to recruit female physicians, says McCartie.

He adds that even if they are full-time, female doctors treat about 80 percent of the patient volume that their male counterparts treat. “[Female doctors] are more likely to get to know their patients and reach out on an emotional level. They have a different approach — and much better if you ask me.”

Rosenstock is a good example of today’s female physician. On the books, she works 22 hours a week (although in reality it’s more like 40 to 45, she says, thanks to all the “gratis” work). Trained as an unusual hybrid — internist/pediatrician — she loves her profession, but she also wants to be there for the finger-painting years of her own kids. And who can blame her for that?



Now wait just a minute

Another major clue that the current primary-care model is not long for this world is the recent proliferation of retail clinics staffed by nonphysician providers. Is this a good development? Maybe. Maybe not. A sizeable 28.1 percent of surveyed physicians expressed consternation that nonphysician providers will “take over” primary care.

Naturally, insurance companies embrace nonphysician providers because they are less expensive, Mosley says. But their presence in the medical world is nothing new, he adds. “Nurse practitioners and physician assistants have been around for a long time,” says Mosley. “They were the only faction that increased its numbers back in the ’90s,” when primary-care physicians were highly sought after to be the gatekeepers and the glue for managed care. It’s easier (and cheaper) to become a nonphysician provider, education-wise.

Over the years, this highly organized group of allied health professionals has lobbied successfully for more and more privileges resembling those belonging to primary-care physicians. Threatening? Maybe. But “resemble” is not synonymous with “replace.” Mosley thinks replacement fears are unfounded, pointing out as an example that certified registered nurse anesthetists haven’t replaced anesthesiologists. “There are still many patients who want to see an MD,” he says.

Rosenstock has no fears that primary care will be swallowed up by nonphysician providers, although she does predict increasing collaboration by the two. Instead, she sees allied health professionals as just that: allies, supporting a common cause. MedPeds’ nurse practitioner Debbie Davis is well-loved by her ever-growing patient panel, says Rosenstock. “We have to take some pressure off primary-care doctors” by reducing the number of patients they see, and nonphysician providers fill that need.

Half full or half empty?

Sixty percent of primary-care physicians surveyed said they wouldn’t go into primary care again if given the chance. That seems really bleak, but it’s actually better than last year, when 62 percent said they’d go in a different direction professionally. And when asked if they would retire today if they had the financial means or hang in there a few more years, this year’s answers echoed last year’s: 45 percent said “today,” and 55 percent said “hang in there.”



To be fair, there was a noticeable increase in those who would stay in medicine but go for a specialty over primary care. But that’s pretty understandable, really, given today’s model that, McCartie says, does not properly recognize cognitive medicine: “If you look at physicians, the ones that make money are procedurists; they cut something or insert something. [Primary-care doctors] have to be high in their class to get into medicine — years of training. Then they come out, and their cap is in the $160,000 to $170,000 range. … Reimbursements for primary care are terrible. The setting up of a practice is difficult. They have a lot of call. It’s hard work.”