Despite high wages, there has been a shortage of primary care physicians in America and the Affordable Care Act, coupled with an increased 'teach to the protocol' environment in medical school, is going to make the shortage worse. 

With medical school costing so much, and increasing procedural limitations on how patients can be treated, doctors are starting to wonder how much of medicine actually requires a general practitioner. Becoming a general medical doctor may not be worth it, according to recent recommendations from doctors that qualified students pursue careers as nurse practitioners rather than as primary care physicians.

In 2012, a survey was mailed to a national random sample of 1,914 physicians and nurse practitioners - 957 each. Responses were received from 467 nurse practitioners and 505 physicians. The responses showed significant differences in how primary care physicians and nurse practitioners view the scope of practice and the overall quality of services provided by the two types of professionals. In a new paper, the authors discusses those responses and the perceptions regarding the supply of primary care clinicians in the U.S., their satisfaction with their current employment and their careers in general, and whether they would recommend that qualified high school or college students pursue careers as primary care physicians or as nurse practitioners. 

Spending taxpayer money convincing people to become doctors is not going to work when even doctors don't recommend being doctors. Over 80 percent of both groups agreed that there is a national shortage of primary care physicians but 66 percent of primary care physicians recommended careers as primary care nurse practitioners. Among nurse practitioners, 88 percent would recommend that students pursue being a nurse practitioner.

Why would doctors recommend that smart people coming out of high school now be nurses instead? The twin cultural pincers of critics insisting they are incompetent or being paid off by drug companies and more government rules and a checklist of defensive medicine strategies and protocols coupled with lower pay make being a general practitioner a thankless job compared to the past.

Nurse practitioners still get to help people, and they seem to be a lot happier than doctors.

"Nurse practitioners report much greater career satisfaction, work fewer hours and have more time with patients. Primary care physicians appear more beleaguered and work longer hours but are better paid. We need a national dialogue that will assure the public can access primary care services provided by clinicians whose roles and skills are clear," says Karen Donelan, ScD, EdM, of the Mongan Institute for Health Policy at Massachusetts General Hospital and senior author of the paper.

"These findings suggest that solving the primary care clinician shortage will require more than simply training a greater number of physicians. Efforts should be aimed at reimagining how the entire primary care workforce should be structured, with one goal of the process being an increase in primary care physicians' career satisfaction," says lead author Catherine DesRoches, DrPH, of Mathematica Policy Research.

Study co-author, Peter Buerhaus, RN, PhD and Professor of Nursing at the Vanderbilt University School of Nursing, adds, "It is unsettling that so many primary care physicians are unwilling to recommend careers in primary care medicine. Most physician-oriented policy initiatives today are aimed at increasing the supply of physicians rather than targeting factors that affect physician work satisfaction. It is a waste of valuable resources to concentrate only on expanding physician supply and ignore changing the practice environment to promote a more satisfied primary care physician workforce. After all, interactions with physicians can exert a tremendous influence on shaping career preferences and decisions among young people."

Citation: DesRoches, Catherine M.; Buerhaus, Peter; Dittus, Robert S.; Donelan, Karen  'Primary Care Workforce Shortages and Career Recommendations From Practicing Clinicians', Academic Medicine, December 23, 2014 doi: 10.1097/ACM.0000000000000591. Supported by grants from the Gordon and Betty Moore Foundation, the Johnson&Johnson Campaign for Nursing's Future, and the Robert Wood Johnson Foundation.