Finding a new internist is VERY tough in HI! Just had this talk with my internist this week. His wife is having a very hard time finding an internist herself. My internist and his partner are in their 60s. They treat me, H, my folks and most of my extended family. He says he keeps asking the med school locally to send students interested in family practice or internal medicine his way. He says he has earned the same low salary for 28 years and is making far less than the hospitalists who earn $300k/year.
It’s also difficult to find good pulmonary (lung) doctors who are younger. I have one who is 49-years-old. My other lung doc just turned 70 and is a long plane ride away and at 5200 feet elevation.
I would imagine the cost of living in Hawaii might make it more difficult. It’s a beautiful place to live but the high cost added to student loans to pay off might make it difficult for younger doctors.
I had to see a pulmonlogist about 5 years ago for something fairly serious. It was going to take months to see someone based on my primary doctor’s recommendation. The primary had to intervene and I still had to wait several weeks for something that was serious/urgent.
Sorry–this site below is easier to read, as no account is needed. It is very tough to see a Pulmo in HI. My allergist, who is a friend and board member of the nonprofit I formed had to intervene so I could see the Pulmo she wanted to refer me to. Even then, I had to wait many months before I could be seen by him.
@HImom there is a shortage of primary care private physicians in many places, not just Hawaii. Internal medicine is considered primary care.
My own doc is in a solo practice but it’s part of a larger group of physicians. He will likely retire soon, and I will go where they send his patients.
I’ve heard of programs where med students will get their loans waived for committing to working for awhile in more rural areas. Seems like a win/win situation. I wonder how widespread and successful it is.
Primary care specialties are among the lower paying medical specialties. Are medical school graduates with $300,000 of medical school student loan debt willing to go into primary care specialties with such a debt burden?
Yes, I am aware of that. What I don’t know is how widespread and successful it is. Maybe its not because there still are shortages but is it a lack of funding? Interest? Like I said, it seems win/win on the surface.
$296,000 Pulmonary care
$196,000 Internal medicine
$195,000 Family medicine
$189,000 Pediatrics
Note that the primary care specialties are three of the four lowest paying ones. Pulmonary care was slightly above the $284,000 average for non-primary-care specialists.
http://www.medscape.com/features/slideshow/compensation/2015/public/overview#page=17 indicates that internal medicine physicians had the lowest overall career satisfaction out of all specialties; they also had the lowest satisfaction with choice of specialty. Pulmonary care specialists were among the lower ones in terms of satisfaction with choice of specialty.
I think Pulmonology is very tough because there are so few really good treatments for lung issues. Many docs that I know prefer to do more sleep medicine, where sleep apnea responds very well to CPAP treatment. Asthma, COPD, pulmonary fibrosis and other conditions are much tougher and patients often have many co-morbidities. The docs often don’t have much time to spend with each of their complicated patients and there is a significant penalty if they are refmitted to the hospital.
Most of the treatments are variants of a few basic meds. There is very little US federal spending on lung research and treatments. Lung transplants generally only improve the short term quality of life and not longevity–rejection and the lungs disappearing from the bottom up (Bronchiolitis Obliterans) continue to be major issues.
My Pulmo docs often spend an hour per appointment with me–they are only supposed to spend 15-20 minutes, which isn’t really enough time for most Pulmo patients.
Things are really upside down. If Medicare and insurers want internists or family medicine MDs to be the “medical home” for patients, the MDs need to be better compensated.
I think that in the future there will be a much bigger reliance on physician assistants and nurse practitioners. There is just too much debt involved for most medical students to pick a lower paying speciality.
I have a friend who is a surgeon in a mid size city. The hospital has actively looked for a partner for years, probably around 10. They hospital has offered a lot of money but it’s been hard. Many new doctors have lots of options and the wives prefer to live in a bigger urban area where they have better career options. Young doctors don’t want to live in mid size cities in the Midwest when they have a bunch of other options.
We live in an upscale area in the MidAtlantic region of the country. Our local hospitals are filled with PAs who do what the doctors used to do. I agree with doschicos - the future is already a reality.
My brother, a recipient of a double lung transplant, drives about an hour and a half to the University of Chicago Medical Center to see his pulmonologist & others on the transplant team. It’s mostly time spent in traffic vs. “distance”.
When you live near a major city with several research hospitals, it’s easy to forget that access is a big problem in many parts of the country!
More PAs and NPs today, yes. But the trick is that more and more programs are just now opening, to train them. Surging around here. Some of the older practitioners today had to take a path that required direct health field experience first, some of that has been streamlined.
If it’s any hope, many med schools and local internists/FPs are actively involved to encourage more med students to go into this arena. And to set a scene that supports that.
I recently had a conversation with a member of my family who finished med school last spring and has matched into a lucrative specialty. He has $300,000+ debt. Said he’d never get out of debt if he’d chosen to go into primary care. Said many of his classmates are doing internal medicine residencies but will then go into more specialized fellowships–cardiac care, oncology, ent, urology, etc etc. Said he knew very few who intended to stay in primary care. Said he’s prepared to forego the very inviting programs that offer loan repayment because of the promise of higher salaries in his specialty. The conversation made me realize what a sad state of affairs exists…I understand his predicament but it still makes me sad.
My PCP is about my age and will be retiring in the next few years, so I will be in the same boat with many who’ve expressed concern here.