Johns Hopkins and the Primary Care Crisis

Originally published in The JHU Politik on October 20, 2013

By 2020, the Association of American Medical Colleges projects that there will be a shortage of at least 45,000 primary care doctors in the United States. That number is expected to reach 65,000 by 2025, as the Baby Boomer generation continues to retire en masse. And the battle will start feeling even more acute as an additional 32 million Americans begin seeking health care under the Affordable Care Act.

Johns Hopkins, one of the most elite medical institutions in the world, has been dragging its feet to address this problem. Between 2006 and 2008, of the 1,148 residents who graduated from Hopkins’ residency programs, only 8.97 percent went into primary care. Only two graduates went on to practice in a Federally Qualified Health Center (an organization that provides primary and preventive care to persons of all ages, regardless of their ability to pay or health insurance status), and not one participated the National Health Service Corps, a program designed to encourage doctors to practice in underserved areas.

In 2009, Hopkins’s residency programs, which receive subsidies from the US government, cost taxpayers $80.7 million. While that number is minute compared to the $2.8 trillion America spends on healthcare, it can certainly be argued that we’re not producing enough of the most needed kinds of doctors, which impacts the efficiency and strength of our healthcare system.

Of course, this problem is bigger than Johns Hopkins. According to a study by Academic Medicine, of the 759 residency sponsoring institutions, 158 produced no primary care graduates at all. Overall, only a quarter of all graduates enter primary care, and yet just a much smaller fraction of those will move to work where care is most scarcely found.

Medical education is expensive; according to the American Medical Association, the average graduate owes $140,000 in student loans. It’s understandable why students would be incentivized to specialize, where the profits are much greater, and where the time-consuming bureaucratic aspects of patient care are much less. Compare the average earnings for a pediatrician, $171,000, to the average earnings for a urologist, $401,000.

Some argue that this is not an either/or fight. That it’s okay for institutions like Johns Hopkins and Massachusetts General Hospital to train more specialists than primary care doctors, because specialists also face projected shortages. But this logic has some holes.

A prestigious institution like Johns Hopkins should be producing the type of doctor we need the most in this economy, and studies shows that primary health care saves money in the long term both for the individual and for the US taxpayer. For example, a study released by the Department of Health Care Policy and Financing looked at individuals who qualify for Medicaid, and found that those who sought primary care were one-third less likely to need emergency visits, inpatient hospitalizations or preventable hospital admissions than those who didn’t. But nearly sixty million Americans live in regions designated by the federal government as primary care shortage areas, even though many of them have health insurance.

Dr. Steve Kravet, the President of Johns Hopkins Community Physicians (JHCP) told me, “We recognize that a commitment to primary care is a key component of our ability to continue to lead the advancement of medicine locally, regionally, nationally, and internationally.” He pointed to JHCP’s 35 primary care locations throughout Baltimore and Washington, and said JHU doctors care for over 200,000 patients in urban, suburban and rural areas of need.

He also cited The Johns Hopkins Consortium for the Advancement of Primary Care, formed just two years ago, as a place to improve societal primary care and health outcomes. He told me that at their first annual retreat this past February, the deans of the Schools of Medicine, Nursing, and Public Health, as well as President Daniels all “spoke passionately” about our institutional commitment to primary care.

I’m glad to see Johns Hopkins stepping up to really prioritize primary care. It’s a crucial responsibility for such an influential medical institution. But I can’t help but wonder, given that people have been predicting this problem since as early as the 1960s, why it’s taken us so long.

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