Doctor Shortage in Rural America

Episode Transcript

Speaker 1 (00:00):
I saw an item the other day that tweaked my
interest about a shortage of you might call primary physicians
or family practice physicians in our country. And we know
that this is true in a lot of cases, especially
in rural areas. And the story indicates that medical students

(00:24):
by and large have other priorities. Many want to be
specialists apparently, And I wondered what the situation was here.
And we're joined for a few minutes by doctor Scott
Shipman from the Creighton University School of Medicine. Doctor Shipman,
good morning, good morning, Good to have you on. Do
you find this to be the case here at Creighton?

Speaker 2 (00:45):
It's certainly the case at Creighton, but it's a pretty
universally trend across our medical schools that students have been
shifting away from an interest in primary care careers.

Speaker 1 (00:58):
Yeah. I would imagine that financial reward is part of
their calculation, right.

Speaker 2 (01:07):
Yeah, It's a complex calculation, but certainly the financial piece
plays into it. Primary care doctors on average do make
considerably less than specialists, and in general, within medicine, those
who do procedures tend to make more than those who
focus more on cognitive medicine or sort of thinking and
working with patients without doing things to them. So those

(01:30):
both work against primary care from a salary or remuneration standpoint.
And there's also a big deal with the debt that
medical studios.

Speaker 1 (01:40):
Yes, I was about to go there, Yeah, I can imagine.

Speaker 2 (01:43):
Yeah, yeah, yeah, that's another big factor. That research has
been somewhat variable in terms of whether that's the primary
driver that debt of people choosing to specialize, but I
think it plays into the calculation.

Speaker 1 (01:56):
Again, what would you say are the most popular choices
for medical students in terms of the specialties that they
want to go into.

Speaker 2 (02:08):
Well, it's a very personal decision for a medical student
and comes with a lot of factors. But the student
is looking to get out of their career in medicine
is certainly a part of it. Who their mentors have
been during their training. We tend to find that the
specialties that are the most competitive to get into, as
one marker of the most popular tend to be those

(02:32):
where they're as the highest salleies and a great deal
of prestige and the satisfaction of doing something to a
patient and making them better. So orthopedics tends to be
quite popular for that respect. Dermatology specialties that you can
feel good about the work you're doing and your patients
appreciate it because there's a clear before and after effect

(02:54):
of the procedure that you've done for them.

Speaker 1 (02:56):
Right, The story that I reference indicates that across the
medical field, some people look down on primary care work,
and there's a term for it called specialty disrespect, which
is sad to hear. Do you think that's true?

Speaker 2 (03:14):
Well, there's I think it's a a not that hidden
secret within the field of medicine that specialties tend to
rib one another a little bit about about why one
is favorable to the other, and that exists across the board.
But I think anyone who has gone into primary care,

(03:35):
considered seriously going into primary care probably has heard some
disparaging comments about you're too smart to go into primary
care or that sort of a thing, which I think
is what you're referencing. And the irony is that I
think most people would agree that the best primary care physicians,
because they have to manage such a breadth of patients'
needs and care for patients holistically, tend to be the

(03:58):
very best doctors of all because of that skill set.
So but the down talk, so to speak.

Speaker 1 (04:07):
Does happen, Yeah, I could, you know, I can only
imagine just from my perspective doctor ship, and I would
think that would be interesting, an interesting field to go
into primary care because, as you say, you see, you
see so much across so many different afflictions and conditions
and sicknesses and so on. I'm curious about something else too,

(04:28):
just based on my experience, because we've seen over the
last thirty some or more years, the landscape has changed dramatically.
When there were so many family physicians that basically had
their own offices, you know, and they had their own nurses,
their own staff, and there was really it was really
a one on one relationship with patients. And I'll never

(04:49):
forget the first doctor I had here. He had an
office like that. And then sometime in the I think
the late nineties, he went over to one of the big,
you know, clinics because he said, the paperwork is killing me.
I wonder if maybe the family physician or primary care
physician job is not as attractive from that perspective as

(05:09):
it used to be.

Speaker 2 (05:10):
What do you think, Well, I think that is another
major factor that has caused burnout in medicine broadly and
disproportionately in primary care. The paperwork, the complexities, the fact
that so much of a physician's time is spent actually
not able to care for patients but having to deal

(05:30):
with all the other things that come along with it,
have only increased exponentially, and primary care tends to bear
the brunt of that. There has been a dramatic shift
away from independent practice or private practice into employed kind
of corporatization of medicine, and I think that does have
a deleterious effect on a sense of autonomy and independent

(05:52):
that many physicians enjoyed in those earlier days.

Speaker 1 (05:56):
Doctor Scott Schipman from M Creighton School of Medicine, thank
you so much doctor for the time this morning.

Speaker 2 (06:02):
Absolutely interesting.

Speaker 1 (06:03):
You appreciate having you on