Are Electronic Medical Records Undermining the Supply of Primary Care Physicians?

Kaiser Health News recently published a cautionary article detailing how US medical school graduates (particularly allopathic graduates) are turning their backs on primary care.

The article notes that in 2019, for the first time ever, the majority of primary care positions in the National Resident Matching Program were filled by international medical graduates (IMGs) and by US osteopathic graduates. Of the 8,116 internal medicine positions available in the 2019 Match, only 41.5% were filled by US allopathic graduates. Of the approximately 4,052 IMGs who successfully matched in 2019, 69% went into primary care.

US medical school graduates historically have been deterred from practicing primary care because of its relatively low pay compared to other specialties. Merritt Hawkins’ 2019 Review of Physician and Advanced Practitioner Recruiting Incentives indicates that the starting salary in family medicine is $239,000 compared to $420,00 in dermatology, $464,000 in urology and $536,000 in orthopedic surgery.

Relatively low compensation is a particular deterrent to US medical school graduates given the high volume of educational debt many of them carry. According to Merritt Hawkins’ 2019 Survey of Final-Year Medical Residents, 48% of US educated medical residents in their last year of training owe $200,000 or more in educational debt, compared to only 25% of IMGs.

But money may not be the only factor driving US medical school graduates from primary care. In emerging value and population-based delivery models, primary care physicians are responsible for coordinating the care of an increasingly older and more acutely ill patient population. This necessitates an inordinate amount of time devoted to entering information into the electronic medical record. To meet quality-based compensation requirements, primary care physicians must meticulously document the treatment protocols they have followed and track the care given to patients who may have multiple chronic illnesses.

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Almost all physicians now are faced with similar requirements, but for primary care physicians, who often have complex patient consultations, documentation requirements can be particularly onerous. The end result is that primary care physicians are less able to focus on and connect with patients – which can be frustrating for both parties. In a national survey of 8,774 physicians that Merritt Hawkins conducted on behalf of The Physicians Foundation, doctors indicated that electronic medical records are the least satisfying aspect of medical practice. Close to 70% of primary care doctors responding to the survey indicated that electronic medical records detract from patient interaction.

Keeping medical school graduates of all kinds – allopathic, osteopathic and international – interested in primary care will continue to be a key healthcare staffing challenge given the ongoing demand for primary care physicians. In 2018, Merritt Hawkins conducted more search engagements for family medicine physicians than for any other type of doctor, marking a record 13 years in a row than family medicine has been our number one search.

The Association of American Medical Colleges projects a deficit of up to 122,000 physicians by 2032, including a deficit of up to 55,000 primary care physicians. Addressing this deficit will require training more physicians, but it also will mean improving the working conditions of all physicians. This should begin with a more physician friendly electronic medical record that allows physicians to spend less time entering data and more time interacting with patients.

Travis Singleton

Travis Singleton
Travis Singleton is executive vice president of Merritt Hawkins, a physician search firm and a company of AMN Healthcare. He can be reached at travis.singleton (at) merritthawkins (dot) com.

Travis Singleton

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