Epperly says medical school students—many of them saddled with between $140,000—$180,000 or even more in student loans—know they can more than double their income right out of medical school by gravitating toward subspecialties.
"The supply pipeline for primary care is just trickling. Only about 10% of medical school graduates are primary care physicians. We are making more and more of the wrong kinds of doctors in America," he says. "Medical school graduates are looking at what kind of doctor they can be and they're seeing they can make two or three or in some cases seven times more in the subspecialties than a family physician; it's becoming a no-brainer for them."
"We've made this point to Congress and big business. You must pay primary care physicians more or you won't get them produced from medical schools. The payment system must change in a way that values what primary care physicians do and pays for it."
President Obama made that point last week when he told the American Medical Association's annual meeting in Chicago that the practice of medicine has devolved into "a model that rewards the quantity of care rather than the quality of care; that pushes you, the doctor, to see more and more patients even if you can't spend much time with each, and gives you every incentive to order that extra MRI or EKG, even if it's not necessary. It's a model that has taken the pursuit of medicine from a profession—a calling—to a business."
Obama has called for compensation reforms that include bundled payments and bonuses that reward physician teamwork, and positive health outcomes, and enhanced financial incentives, like loan forgiveness, for medical students who choose primary care. Will that be enough? It's hard to say.
The Obama administration has also indicated that it's not willing to increase Medicare reimbursements, which would mean slicing the pie differently. Subspecialists wouldn't be happy about taking a smaller piece. But, if we're truly going to make healthcare more cost efficient, then we will have to take Epperly's observations seriously, remove the perverse incentives, and apply the laws of supply and demand.