The Brave New World Facing Residency Graduates in Primary Care

Now is the time for the usual congratulations as the long span of college and medical school and residency training comes to an end. You will not have been informed about the following, but sooner or later you will figure this out

1. Too many graduates and increasing
2. Steady declines in independent practice opportunities
3. Fewer, larger, and more powerful health care employers
4. Declines in independence and autonomy dictated by the above
5. Health care outcomes are about patients and their environments from birth to encounter, not health care encounters. Social determinants and non-clinical factors drive outcomes just as they drive access to care, health insurance quality, housing, environments, employers and more. You might change the odds ratios, but the ultimate outcomes are already set in ways difficult to change

If this is your first residency graduation, then it is not likely to be your last as you will likely be entering a fellowship now or in the future. The fact of the matter is that generalists and general specialists, those emerging from primary care or women's health or basic surgical training, are least supported by the financial design. You will also want to move to a career less likely to be undermined by the 50,000 NP and PA graduates emerging from training - and increasing at 5 to 6% more each year.

Health care employers will continue to focus on profits

1. Less costly health professionals
2. Fewer most costly health professionals

Physicians may want to focus upon high revenue generation areas not likely to be done by NP and PA - procedural, technical, subspecialized - the ones most rewarded by the financial design that shapes higher salaries and benefits and more and better team members.

Studies tend to indicate that higher salaries drive career decisions, but better financial designs shape the whole package for higher salaries, better benefits, and more and better team members to share the burden of care.

Speaking of Experienced and Dedicated Health Care Team Members

A sad side effect of massive overexpansion is an increase in the proportions of the workforce with no or low levels of experience, particularly NP due to the most massive expansions of annual graduates (plus fewest active, plus shortest careers, plus departures from areas such as primary care or moving between specialties)

As long as expansions continue at 6 to 10 times population growth, there will be workforce less and less experienced.

Just thought you might want a heads up about what past and present health care leaders have done to shape your career.

They are certainly not going to tell you that they will be

1. limiting graduates or
2. focusing on a more experienced workforce or
3. utilizing more inexperienced workforce more and more