than they would like. “This goes against what patients want,” says Kephart, who also is a past president with the MAFP and a board member of the Hennepin Medical Society. “They want doctors to spend time with them, talk with them, and help them deal with their problems when they get sick.” Higher reimbursement for counseling services is needed to help family physicians recommend healthy lifestyle choices to patients, Kephart says. “There are certain times in people’s lives when they want to make changes — quit smoking, eat better and lose weight. There is zero money for things that are beneficial to patients,” he says. “To maintain the same income you have to see more patients,” says Lynne Lillie, M.D., a family physician at HealthEast’s Woodbury Clinic and incoming MAFP president. “My income and benefits have gone down, but my clinic day doesn’t change. I have an appointment slot every 18 minutes, starting at 8 a.m. and running until 4 p.m. Some patients may get two slots, depending on what they come in for. Once every two weeks I may stay until 11 p.m. to do paperwork.” But Lillie says the biggest challenge for practicing family physicians is taking care of the patient who is in front of you. “I used to practice in a small group model.…More doctors are leaving that model and going to employment at hospitals. You need a bigger system to balance reimbursement losses.” While there are no exact figures, Lillie estimates that 75 percent of family physicians in the Twin Cities are employed by hospitals. “Hospitals ask doctors to see more patients, but patients are not that excited about being in a waiting room full of patients to see their doctor for 15 minutes. It is a challenge for us,” she says. Family physicians are also concerned that fewer U.S. medical school graduates have chosen family medicine the past 10 years. USMGs in family medicine residencies in 2005 accounted for 38 percent, or 1,350, of total first-year family medicine residents. In 1997, some 2,340 USMGs, or 76 percent, chose family medicine. “Medical students aren’t going into family medicine because reimbursement is low and they have high medical school debt,” says Thorson, who also is a board member of the Ramsey Medical Society. Family physician income averages about $150,000 per year and medical school debt averages $163,000, according to the AAFP. Schoephoerster, who was a residency program director for six years, also says medical students are thinking more about lifestyles than older generations. Younger physicians also want to work fewer hours than their older peers. “It becomes easier to have a day job in radiology than in family medicine,” he says. “They also see burned out and tired family physicians who have to churn patients instead of developing relationships with them because of the way the current fragmented health care system is structured. That keeps them away.”
“Medical students aren’t going into family medicine because reimbursement is low and they have high medical school debt,” says Thorson.
(Continued on page 14) MetroDoctors
The Journal of the Hennepin and Ramsey Medical Societies
March/April 2007
13