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Primary care shortage starts now

The Carnegie Endowment is expected to recommend that all medical schools create three-year primary care programs.

The new health reform plan is based on a program already underway in Massachusetts, where one of the first unintended consequences was a shortage of primary care.

(Neil Patrick Harris really was just a kid when he first starred in Doogie Howser M.D. in 1989.)

It makes perfect sense. Put everyone on insurance, tell all the insured they can get free check-ups, and there's going to be a rush of demand like you've never seen before.

One partial solution is in-store clinics like those at CVS and WalMart, staffed by nurses or physicians' assistants, and linked to doctors using electronic medical records.

Such clinics can quickly do procedures primary care doctors often do -- like trim ingrown toenails. But they do it for less, often without an appointment.

Another route, proposed by the Administration, is to give primary doctors raises under Medicare. If you remember the old TV show Northern Exposure, you've been exposed to the National Health Service Corps which can, among other things, forgive some medical school loans if you go into an underserved area.

A third stopgap solution is to import doctors from other countries. Two California professors, writing in The New York Times, are proposing free immigration for all medical workers currently earning over $75,000 per year, and the training of pharmacists into elements of primary care.

A more straightforward route is to simply increase the supply of primary care physicians. To that end Texas Tech has launched a three-year training program for primary care doctors. That's half the time it usually takes to complete medical school, internship and residency programs.

Compared to the size of the program, the Texas Tech program is a drop in the bucket. The school usually graduates 10 doctors in primary care, and will take just 10 in its first three-year class.

What may be more important is that the accrediting authority is sponsored by the Association of American Medical Colleges and the American Medical Association. This makes it easily replicable. The Carnegie Endowment is expected to recommend that all medical schools create three-year primary care programs.

Doogie Howser indeed.

This post was originally published on Smartplanet.com