The Michigan Academy of Family Physicians advocates raising the annual MIDOCS appropriation in the MDHHS budget from $ 6.4 million to $ 10.9 million, plus a $ 3.6 million one-time appropriation investment to stem the emigration of freshly minted primary care physicians from Michigan:
Michigan’s family doctor shortage is worsening. More investment could help, advocates say
By Mark Sanchez - April 1, 2024The Michigan Academy of Family Physicians and the state’s medical schools are pushing for more funding to address a critical shortage in primary care doctors in the state. Credit: Michigan State University College of Human Medicine
The percentage of medical students opting for primary care medicine declined again this year, raising further concerns about the ability to provide frontline care for patients in a worsening national physician shortage.While the number of medical students seeking a residency position in family medicine and the number of positions filled both increased nationally, the percentage of unfilled slots in primary care also grew.
Of the record 5,213 residency slots in family medicine at 796 programs across this country, 636 (13.8%) went unfilled, according to the National Resident Matching Program.
That compares with 12.7% of 5,088 open family medicine residency positions that went unfilled in 2023 and represents a sizable rise from 2020, when 8% percent of positions were left unfilled.
The data point to demand outpacing supply and a worsening shortage of new family medicine doctors entering the field.
“We are facing a shortage of family medicine physicians that is going to affect the health of Michigan,” said Dr. Kristi VanDerKolk, program director for the family medicine residency program at Western Michigan University Homer Stryker M.D. School of Medicine in Kalamazoo, also known as WMed.
VanDerKolk spoke in a recent media briefing hosted by the Michigan Academy of Family Physicians, which represents more than 4,300 family physicians, family medicine residents and medical students statewide. She and others advocated for increased spending to support medical education and students who decide to pursue primary care as a specialty.
“The question really, I think, is how to do better, and one place to start with that is to invest in primary care,” VanDerKolk said. “We need increased investment by the federal government, state government as well as payers to be able to improve and increase the number of physicians that are working in primary care in Michigan and beyond.”
In the annual national Match Day on March 15, where medical students learn where they will serve their residency, four of the 75 students at the Kalamazoo-based WMed were placed in family medicine slots. Two of them were placed in positions at University of Illinois College of Medicine in Chicago and University of Michigan Hospital in Ann Arbor. The other two will go to University of Utah Health and UP Health System in Marquette in the Upper Peninsula.
VanDerKolk cites how just one-quarter of the medical students enrolled at Michigan universities plan to go into primary care. That compares to one-third nationally.
Fewer medical students pursuing primary care because of administrative burdens, inadequate insurance reimbursement, a preference among many for a more limited scope of practice, and an “underappreciation of family physicians,” said Dr. Beena Nagappala, president of the Michigan Academy of Family Physicians and a family doctor in Clinton Township.
This year’s Match Day data and the present trend “underscore the worsening shortage of primary care physicians as a concerning trend in Michigan and nationwide,” Nagappala said.
“More investment will go a long way to address this crisis, leading us toward a better health care future,” she said. “And we want to continue to strengthen and expand access to care, which becomes difficult with less of us in the field.”
Pay gaps
As debt-ridden medical students weigh which specialty to enter, their financial situation and potential earning power often can weigh heavily on the decision, said Dr. Aron Sousa, dean of the Michigan State University College of Human Medicine.
Nationally, primary care physicians in 2022 earned a median $300,000 in total compensation, versus more than $500,000 for surgical specialists and more than $400,000 for non-surgical specialists, according to the most recent compensation report from the Medical Group Management Association (MGMA).
Signing and starting bonuses for primary care physicians also were smaller at a median of $20,000 in 2022. That compares to $25,000 for nonsurgical specialists, and a $25,000 signing bonus and $30,000 starting bonus for surgical specialists, according to the MGMA.
“One of the things that you see nationally is that primary care is not paid the way other parts of medicine are, and as students have large amounts of debt, it’s reasonable for them to think about their ability to pay off that debt in the future,” Sousa told Crain’s Grand Rapids Business.
Last year, 48% of MSU College of Human Medicine graduates chose a residency in primary care, which includes family and internal medicine and pediatrics. That was up from 42% in 2020, although the percentage declined to 37% for 2024.
Nationally, 46.8% of medical students sought residencies in family or internal medicine or pediatrics, according to the National Resident Matching Program.
MSU’s medical school graduates about 190 students annually and has always placed an emphasis on primary care during clinical training, according to Sousa.
“We work hard at it,” he said. “We are a community-based medical school, so they get a powerful experience in community with family physicians who are taking care of people in every part of life and are a key part of the health care system in their community. We’ve been intentional about this since founding in the 1960s. It’s a part and parcel of our culture and how we think of ourselves as a part of providing the workforce for the state of Michigan.”
At 17.2%, family medicine in 2024 ranked as the top area that MSU medical students chose for their residencies, followed by emergency medicine at 15.6% and internal medicine at 12.2%.
The Michigan Academy of Family Physicians advocates for continued or higher funding for MIDOCS as one solution to get more medical students to go into primary care. Short for Michigan Doctors Improving Access to Care, MIDOCS is an initiative the state and four medical schools — WMed, MSU, Central Michigan University and Wayne State University — started five years ago to steer graduates to serve a residency and then work in an underserved market for two years. In exchange, they receive a $75,000 grant to use to pay medical school debt.
Since 2019, MIDOCS has helped to fill 124 new primary care slots around the state.
More funding
In the current fiscal year, state legislators appropriated $6.4 million to MIDOCS. Gov. Gretchen Whitmer’s budget proposal for the 2025 fiscal year would again allocate $6.4 million.
The Michigan Academy of Family Physicians advocates raising the MIDOCS appropriation to $10.9 million, plus a $3.6 million one-time investment to increase loan repayments for existing medical residents.
“It’s important that we have funding for this program because we see these people that need care,” said Dr. Fermin Rankin, a family physician who graduated last year with the inaugural class for the Central Michigan University College of Medicine and works at Great Lakes Bay Health Centers in Bad Axe.
MIDOCS, which participating medical schools also fund, encourage students who graduate from a Michigan medical school to serve a residency in the state and practice here, Rankin said.
“We’re exporting more physicians in Michigan than we’re importing, so we need a way to maintain our people here,” he said. “We have half of our residents that are graduating, and I know quite a few of them leave the state of Michigan. MIDOCS is helping to maintain and retain those people.”
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