アメリカ開業医の独り言

アメリカでは、給料の少ない、FP（家庭医）PED（小児科医）IM（内科医）が減少している。日本では、産科医、外科医、小児科医が、減少そして不足している。 　USA TODAYのアメリカの水曜日の朝の第１面に出ていてびっくりしました。この記事は、JAMAの記事をもとにしています。放射線科医の初任給の＄３５０、０００に比べると新人の家庭医＄１３０，０００の差は約三倍です。ハイリスクハイリターンのアメリカです。家庭医には２％しかならないという医学生の統計です。驚きました。医者も仁術でなく算術になってきたアメリカです。
	New doctors avoiding most-needed, worst-paid field: general practice   E-mail | Save | Print |
	Enlarge By Michael A. Schwarz for USA TODAY First-year medical students listen to a biochemistry lecture at Florida State University College of Medicine in 2005. Across the nation, medical students are graduating with an average debt of $140,000, making the relatively low pay and long hours of a general practice less attractive.  DOCTORS' STARTING SALARIES 2007 averages: Radiology: $350,000 Anesthesiology: $275,000 General surgery: $220,000 Otolaryngology: $220,000 Emergency: $178,000 Neurology: $177,500 Psychiatry: $160,000 Internalmedicine: $135,000 Family medicine: $130,000 Pediatrics: $125,000 Source: The Journal of the American Medical Association

Many medical students are turned off by the thought of caring for chronically ill patients and the amount of paperwork general internists must deal with, says lead author Karen Hauer, a general internist on the faculty of the University of California-San Francisco.

"They rated the intellectual aspects of the field highly, and they rated continuity of care appealing," Hauer says. "When you put the whole package together, it's too hard."

On top of the workload, a "research letter" in the same issue of JAMA as Hauer's study ranked internal medicine as one of the lowest-paid medical specialties.

Members of the medical school class of 2007 graduated with an average debt of $140,000, writes Mark Ebell, a family practice doctor at the University of Georgia.

That's $5,000 higher than the average starting salary of internists that year, according to Ebell, who didn't separate the more lucrative internal medicine sub-specialties, such as cardiology and gastroenterology, from general internal medicine.

Radiologists topped Ebell's list, with a starting salary of $350,000, not to mention, Hauer notes, more regular hours than general internists.

Their amount of debt didn't seem to influence their choice of specialty in her survey, Hauer says.

Rather students focused more on quality of life factors such as income and work hours, which did steer them away from general internal medicine.

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Study in JAMA study links primary care shortage with salary disparities

Athens, Ga. – The nation's shortage of primary care physicians has been linked to a host of poor health outcomes, and a new study published in the Journal of the American Medical Association suggests that salary disparities play a major role in the shortage.

Dr. Mark Ebell, a professor and assistant to the provost at the University of Georgia, compared 2007 starting salary data for various physician specialties with the percentage of medical school graduates choosing those specialties. He found a strong, direct correlation between salary and the popularity of a specialty.

"Countries with the healthiest primary care systems tend to have the best health outcomes," Ebell said. "We rank behind many countries in the quality and efficiency of health care, and I think a lot of that is because we have neglected primary care."

Among his findings:

Family medicine had the lowest average salary ($185,740) and the lowest percentage of filled residency positions among U.S. graduates (42 percent). Radiologists and orthopedic surgeons, who had an average salary of more than $400,000, had the highest percentage of filled residency positions among U.S. graduates (88.7 percent and 93.8 percent, respectively).

The link between average salary and the popularity of a specialty is not surprising, particularly to Ebell. He conducted a similar study nearly 20 years ago and found the same relationship. Since then, however, the salary disparities have grown and the shortage of primary care physicians—which includes those who specialize in family medicine, pediatrics or general internal medicine—has become more pronounced. In the past decade alone, for example, the number of U.S. medical school graduates entering family practice residencies has dropped by 50 percent. Studies have linked a lower percentage of primary care physicians with higher infant mortality rates, higher overall death rates and more deaths from heart disease and cancer.

Ebell said he conducted the study to draw renewed attention to the role of salary disparities in the primary care shortage and to encourage policymakers to enact meaningful reforms to increase the percentage of primary care physicians.

"The problem of salary disparities is not something that anyone is going to solve locally," Ebell said. "This is something that will require reform at a national level."

He said one possible reform is expanded debt relief for students who choose primary care practices and in particular those who choose to practice in underserved areas. He notes that the average debt for a medical school graduate has quadrupled—from $35,000 to $140,000—in the nearly 20 years since his original study. When students graduate with the equivalent of a mortgage in debt, he said, they can't help but be drawn to high-paying specialties rather than primary care.

Changes to insurance reimbursements, which currently hurt primary care by rewarding the delivery of diagnostic tests and medical treatments over time spent communicating with patients, are also needed to reduce salary disparities, he said, and have the potential to improve quality of care by reducing unnecessary or duplicative interventions.

Ebell said the broad knowledge base of primary care can be intimidating to students, so creating information technology systems to manage information will be important. Exposing students to primary care physician role models is another way to sustain interest in primary care throughout a student's training.

"A career in primary care can be very rewarding," Ebell said, "and mentors can show students the satisfaction that comes from building relationships over time with patients."