Estimating the Residency Expansion Required to Avoid Projected Primary Care Physician Shortages by 2035

We would like to commend Petterson and colleagues for their thoughtful analyses of projected shortages of primary care physicians. The strengths of the analyses include taking into account newer models of primary care delivery, the growth of the hospitalist movement, and the projected increase in primary care visits due to the newly insured from the Affordable Care Act. It is not surprising that such a shortage of primary care physicians is projected. For decades, primary care has been undervalued and has lacked the appeal of other competitive specialties among our nation's medical students. We could not agree more with the authors that the number of residency slots needs to be increased given the recent increases in medical school class sizes and sheer numbers of schools. However, it is important to understand the multifactorial reasons why current medical students do not choose primary care even when ample slots are available for them. While salary disparities between primary care and specialists are an oft cited factor, recent studies also point to an even greater importance of time off and a controllable work schedule. In addition, medical schools currently may not do enough to expose students to primary care physicians who have successfully developed clinical practices that allow them to thrive intellectually, financially, and personally. Without these model physicians, it is unlikely that students will pursue primary care long-term. Simply expanding primary care residency programs without addressing these factors will not address the primary care physician shortage. Primary care has to become a highly desirable field and not a career path of last resort. In considering the best way to care for future Americans, we should ensure that future primary care workforce is not only healthy in number, but also in job satisfaction.

Competing interests: None declared