Why Don't We Make Medical School Free If We Want More Primary Care Physicians

Several weeks ago, the New York Times ran an article detailing a program started by Medicare to hire “mystery shoppers to call the offices of primary care physicians to see if they were talking new patients or patients, how long waits are, and how they respond to patients who have private insurance or patients with public insurance like “Medicaid.” Physicians, not surprisingly, have responded with outrage, and CMS quickly abandoned the program.http://www.nytimes.com/2011/06/27/health/policy/27docs.html?pagewanted=all

The program was started to help tfigure out how to deal with the primary care physician shortage and to make sure that the 30 million new patients covered by the soon to be implemented (hopefully) PPACA (Patient Protection and Affordable Care Act), which depends on primary care, will actually be able to find a primary care physician in a country with a notorious shortage of people going into primary care.

I have no problem with the government trying to collect data about physician willingness or ability to take new patients or on whether they discriminate against people on Medicare or Medicaid.  Since the government — and that means us the taxpayers — are a huge funder of graduate medical education, I’ve always wondered why we’ve allowed physicians of any sort to refuse to accept patients with public rather than private insurance.  But all of this begs the fundamental question.  If we want more primary care physicians, why don’t we just get over it and pay their medical school tuition, with the obligation that they will have to pay back the cost of their education if they don’t remain in primary care for a significant number of years (and I don’t mean two years in the military or working on an Indian reservation, both of which are certainly worthy endeavors but hardly pay back the investment we, the taxpayers, have made in them.

Consider the math — which I would like to actually check on.  The average graduating doc, has $100,000 or more in medical school debt.http://www.studentdoc.com/medical-school-loans.html.  So if the government shelled out $100,000 for their education, this would be like giving them a $100,000, compounded with interest over a period of years, or wisely invested (even today) the return on this investment would be significant.  If education for PCPs was free or at very low cost, maybe that would go a ways to ending the catastrophic shortage of primary care doctors.  

Leave a Comment