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3 Reasons Why Primary Care Residencies Shouldn’t be in Hospitals

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Should primary-care physicians be receiving their training in hospitals?

This is the question posed by Dr. Bruce Koeppen of Quinnipiac University in an opinion piece for Live Science.

“If healthcare's goal is to keep patients out of the hospital, why are primary-care physicians training in hospitals?” he asks.

He then lists three reasons why PCPs should be trained elsewhere:

1. They may reconsider becoming a primary-care physician after encountering the higher-paid specialists at the hospital.

2. The present state of the system as it struggles to adjust to the ACA bringing “millions of previously uninsured Americans into the healthcare system” is tenuous at best.

“…[T]he flaws in our current system of hospital-based residencies and reimbursement practices have reached critical mass,” Dr. Koeppen writes.

3. The unavailability of hospital residencies will only increase over the next few years.

“By 2017, the number of American medical school graduates (MD and DO) will exceed the number of existing residencies,” he writes. “And, without a residency, physicians—who dedicated years to the pursuit of a medical education and incurred significant debt doing so—will not be able to practice medicine.”

In fact, in 2013, “more than 400 medical school graduates across the United States did not receive a residency match.” And given the state of the reimbursement system, Dr. Koeppen adds, the likelihood of hospitals funding additional primary-care residencies is low, since the incentive is for them “to fund...residences in specialties that produce revenue, such as cardiology, gastroenterology, and orthopedic surgery…”

Dr. Koeppen believes the 11 Teaching Health Centers, non-hospital residencies for PCPs that are funded by the ACA, is a step in the most productive direction, dubbing them “the right kind of residency programs to nurture aspiring primary-care physicians.”

“Primary care is delivered outside hospitals,” he writes, “and residency training for primary-care disciplines must also take place, predominately, outside hospitals. We need to learn from these Teaching Health Centers, expand them, and provide new training sites with stable funding beyond the term of these initial grants.”

Are there physicians reading this who are going through residency or looking for a residency and struggling to find openings at hospitals? How is this affecting your career outlook? Have you contemplated changing to a higher-paying specialty?

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