65 million isn’t just the number of years that have passed since the extinction of the dinosaurs. It’s also the number of Americans who live in a community with less than one physician for every 3,500 people. Now, whether you’re a doctor or not, can you imagine having over 3,500 patients? Why are there areas where the availability of medical care is so sparse? Why can’t more doctors just be hired in these communities to fill the void? Well, because generally, physicians aren’t interested in taking those jobs. Why? Because much of the need for medical care in these communities calls for the services of primary care doctors. You might be saying to yourself, “so what…” We’ll get there.

First, put yourself in the shoes of a medical student in the home stretch of an utterly exhausting and perhaps overwhelming grad school experience. Along with a white coat and a freshly minted diploma, you are now also the proud owner of a small fortune...of student debt. These days, medical school costs quite a bit more than you’re EMT or ACLS certification. Not surprisingly, many students upon graduating from medical school make paying off their student loans priority number one. Thus, as these students are exploring career options within the medical field, it is not surprising that many of them gravitate toward positions as specialists, where the compensations is significantly higher than for a position as, say, a primary care doctor.

This brings us back to our original predicament. Far fewer physicians are interested in working for small, basic, perhaps rural operations because they require primary care docs first and foremost and primary care docs don’t make as much as other specialists. To put this in perspective, let’s take a look at just how wide the pay gap is between a specialist and a primary care practitioner.

According to a survey conducted by Modern Healthcare, the highest paid specialists in the medical field include orthopedic surgeons with a median salary of $579,000, invasive cardiologists with a median salary of $576,000 and radiation oncologists with a median salary of $516,000. Compared with the $228,000 that is the primary care doctor’s median salary, it becomes clearer why physicians are avoiding this route. Mind you, becoming a specialist requires more school, training and competition. But think about it. If it meant doubling your salary - even to a half million dollars? Unless you have your heart set on being a family doctor, it almost seems like a no-brainer.

So, what is being done about this recruiting barrier? What can be done? Well for starters, the basic economic principles of supply and demand tell us that with a greater demand for primary care doctors, we can expect to see compensation increase for jobs that fall within that bracket - and it has. Multiple surveys have reported that the median salary for primary care doctors has been on a steady incline as the aforementioned gap in pay has become a more visible problem. In addition to a flat increase in pay (which still does not seem to come close to compensating for the sharp contrast in wages), hospitals and other medical employers in the market for primary care doctors have devised other ways of competing for the interest of new doctors. Some of these methods include signing bonuses (ranging from amounts in the thousands to the tens of thousands) and the coverage of relocation fees. Some organizations have even begun offering loan forgiveness for fresh medical school grads. While this does not close the gap, it certainly eliminates much of the sense of urgency to compensate for a mountain of student debt that is often involved in a post-grad school job hunt.

While we probably won’t see the wage gap between specialists and primary care docs narrow by any great measure, based on the combined efforts of medical employers to recruit more competitively and the direction of the market, it is reasonable to anticipate an increase in primary care docs.