Changes on the job front

Pediatricians outpace both internists and family practitioners when it comes to a positive outlook. Although all three groups express more optimism regarding the job market than they did a year ago, the results show that one out of every five pediatricians — more than triple the figure from last year — believes that future job trends look pretty rosy for primary care.

Mosley describes recruiting as akin to calling a “plumber in the middle of the night. You don’t call us until the demand is really there.” Lately, those calls for primary care have really been coming in. Between April 1, 2006, and March 31, 2007, Merritt, Hawkins tallied 639 client requests for generalists — more than any other specialty, and nearly double the number in 2003.



The physicians themselves are noticing the change too. Nearly a third report receiving four to six recruiting calls within the past year; and more than 17 percent say they’ve received up to 10. And although roughly half claim they’re being recruited at about the same rate as two years ago, 37.4 percent think it has increased — more than double that of last year. This should help with sagging physician morale, says Mosley. “When you have that optimism of ‘I’m going to be needed,’ the market picks up.”

Some damage was certainly done when managed-care organizations pushed for primary-care docs to serve as gatekeepers back in the ’90s. Many medical students shied away from choosing primary care after that. Illustrating the point, just one of the 25 internal medicine residents at Yale Medical School intends to pursue primary care, McCartie discovered during a recent visit. Clearly, supply is not keeping up with demand at the moment.



This shortage has made recruiting for the field “brutally hard,” says McCartie. “Ten years ago, when everyone thought primary cares were going to rule the roost, and you got a primary-care search, you were delighted. Today, those are hard searches.”

They love me, they love me not

Primary-care physicians continue to struggle with their perceived standing, both within the medical hierarchy and society at large.

Fewer than 15 percent of surveyed physicians see themselves as being treated as equal partners with specialists. A majority (53.6 percent) say they’re treated as “2nd class” citizens, up 5.7 percent from 2006. Internists and pediatricians voiced the biggest change in attitude, with internists at 60.1 percent and pediatricians at 48.8 percent (both rising roughly 8 percent). The family practice figure also rose, but more modestly, from 48 percent to 51.3 percent.

But what’s at the root of this suspicion that the medical world doesn’t respect them? As Rosenstock points out, specialists realize a more consistent return on the clinical care they give: A distressing percentage of what primary-care docs do is uncompensated. A provocative and volatile situation, for sure, but not necessarily the specialists’ fault. Rather, it’s the way the current reimbursement model is structured. Still, who wouldn’t feel undervalued, working just as hard as a specialist but being reimbursed for so much less, regardless of where the fault lies?

Rosenstock believes the physicians in her practice do receive the respect they deserve from most specialists. “If we figure out that somebody doesn’t value us, there are so many that do,” she says. She largely credits the EMR her practice adopted three years ago, which greatly facilitated communications between MedPeds and specialists. “That makes us feel less out of the loop. They’re more prepared when they see our patients, so it’s better. There’s really no excuse not to communicate with us anymore,” she says.

Medical home, sweet home

Despite a decade of being kicked around, primary-care practices persevere. Why? Because they offer what no specialist can: A medical home. “Even if our patient sees a specialist,” says Rosenstock, “we still get the call, ‘I’m still having stomach pain.’ The specialist is better at saying ‘I’ll see you in two weeks.’ And a lot of people don’t feel comfortable calling a specialist.”