Colorado's physician pipeline half empty


Colorado is facing a critical shortage of physicians -- particularly family physicians -- to meet the health care needs of its growing population.

There are more than 1,600 family physicians currently practicing in Colorado but recent projections indicate that the state will need an additional 550 family physicians -- about a 40 percent increase -- if the state is going to provide appropriate health care and access for the anticipated population growth in the state between now and 2030.


Family doctors make up the majority of physicians in the state, 55 percent of all primary care physicians. In rural areas of Colorado, they comprise 73 percent of the primary care workforce. Yet today there are areas of the state where there are no practicing family physicians. All but five of the state's 64 counties would be designated full or partial health professional shortage areas without family physicians.

The physician pipeline in Colorado is half empty, in part, because the majority of physicians are practicing in more affluent urban and suburban communities. That leaves most of our rural and inner city areas without adequate access to primary care.

A more serious long-term problem facing Colorado and most other states is the shrinking supply of medical school graduates who are electing primary medicine as a specialty. The number of medical school graduates who entered primary medicine has declined by about 50 percent in the past 10 years. Many graduates of the University of Colorado School of Medicine, beginning their careers with an average debt of $120,000, are passing primary care for more lucrative specialties and subspecialties.

There's a serious gap between what primary care physicians on average earn, and what subspecialists earn and that disparity is growing. It's a major reason medical graduates are rejecting careers as family physicians. Primary care physicians are the principal providers of care for Medicaid, Medicare and CHIP patients, but receive lower reimbursement rates for those government programs, creating further disincentives for practicing family medicine.

Recent studies have clearly shown primary care medicine is effective in both lowering health care costs and improving the overall quality of care for patients. Primary care physicians are critical to managing the increasing numbers of elderly patients and patients with chronic health care conditions.

What must be done to avoid a serious threat to our health care system in Colorado and the nation?

We need to make primary care specialty financially rewarding if we have any hope of re-establishing a healthy primary care base. As stated in a recent article in the Annuals of Internal Medicine, "Primary care practice is not viable without a substantial increase in the resources available to primary care physicians."

We must embrace the concept of a personal medical home through which all Coloradoans can receive acute, chronic and preventive medical services. Through an ongoing relationship with a family physician, patients can be assured of care that is not only accessible and affordable, but is comprehensive, accountable, safe, timely and satisfying.

Colorado needs to grow its primary care base, particularly in rural and underserved areas of the state. Perhaps it is time for our medical schools to use some indicator of a student's tendency to go into rural or inner-city practice as one of the criteria for getting accepted.

In any event, we must make a career in family medicine more desirable to tomorrow's medical students.

Larry Kipe is a family physician in Craig and is currently serving as president of the Colorado Academy of Family Physicians.

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