[dbussone]

Originally Posted by golfing eagles

Well, now that you mention it........



The first problem is national---The number of primary care doctors is shrinking rapidly. Currently there are a total of about 900,000 clinicians in the US, 624,000 are involved in direct patient care, and 209,000 are in primary care. Some estimates expect the total number to decrease by 250,000 in the next 5-7 years due to a variety of factors----early retirement, alternative careers , and medical careers that do not involve patient care.

Young physicians are trending towards specialty and sub-specialty care---as the technology develops and the body of knowledge expands exponentially, there is much more to know and new niches to fill. Primary care, in particular suffers because it is considered less "glamorous", overburdened by documentation and regulation, and to a certain degree is less lucrative.

As a result, recruiting is much more difficult all over. I don't know how the recruiting goes in TV Health---I believe they were originally aiming for 8 centers with 8 docs each, but they have taken a pause. I honestly don't know the reason but recruitment may be a part of it. Personally, I don't think hiring standards can ever be too high, but realism has to set in at some point. Yes, their goal is a fairly new concept, they want to build the best ACO possible, and this involves a lot of paperwork and regulation. This is why they try to limit patient profiles to 1250 patients/physician, have 1/2 hr follow up appts and 1 hr initial appts, which is about 1/2 of the national average.

I don't think salary is a huge factor. Those who are chasing dollars have already decided to go into specialty care, or avoid a medical career entirely and go to Wall Street--it's a lot easier to get a MBA than a MD. It appears the salaries offered at TV Health are about average for primary care, so they are competitive in their financial package.

I hope this answers some of your questions, IMHO.

GE - I would add that the Feds also have a significant hand in this situation. Despite the fact that our country's population is growing, and the number of elderly is increasing, the Feds capped the number of residency positions in the late '90s. This is simply a matter of money. The Feds partially reimburse teaching hospitals for the cost of training physician so they capped the number of available slots to reduce future expenses. In essence there is an artificial choke point on the training of physicians regardless of current or future need IMO.