I have published a number of previous notes about primary care physicians (PCPs), two recent ones in particular that suggested the need for them to upgrade their skills in order to survive (see: Have PCPs Become Obsolete?; More on Redefining the Role of the PCP). It had never occurred to me until reading a recent blog note (see: Are General Surgeons the Primary Care Docs of the Operating Room?) that general surgeons may be in somewhat the same boat as PCPs. Below is an excerpt from the note with boldface emphasis mine:
The number of general surgeons per capita has fallen by about 25% in the past quarter century...One key driver of this trend is a move toward specialization by young docs. In 1992, 55% of surgeons did a subspecialty fellowship after finishing surgical residency; now that figure is over 70%, the authors report. This sounds a lot like what’s happening on the medical side of the profession, as younger docs increasingly head for medical subspecialties that often pay more and give doctors more control over their work life than primary care jobs. The primary care version of surgery seems to be general surgical call at the hospital for things such as abdominal emergencies and trauma; [researchers have noted that] surgical subspecialists are qualified as general surgeons, [but] they sometimes seek to avoid this burden [of hospital surgical call].
When you think about the professional role that has evolved for PCPs and now, apparently, general surgeons, it's no wonder that young trainees seek to subspecialize. Throw into this mix the fact that performing a " procedure" can double your income (see: Performing Procedures Can Be Lucrative for Physicians) and its a wonder that we have any generalist physicians at all.
For me, the on-call issue is a distraction that can be solved relatively easily. The hospitals can hire their own surgicalists about which I have previously blogged (see: The Emergence of the Surgicalist) and taking a fair amount of call will be a condition of their employment by the health system. In terms of referral patterns and with a shortage of general surgeons, I envision that the PCPs will refer to the surgical subspecialists. But what happens if there is a shortage of PCPs?