Kevin, M.D. - Medical Weblog

General internal medicine is also a dead end. This is a serious problem and no one outside of medicine understands it. The lead-footed government has created incentives for young doctors to avoid these career choices like the plague. In twenty years if someone has a fever and "feels bad" they will have a problem deciding which specialist to go see, as there will be no more "general doctors".

I think everyone can see clearly that it is a bad thing not to have quality primary care doctors, but why isn't anything being done about it? Is my assumption incorrect? Will it be better to have a pure specialist system with more retinal specialists than internists?
b
 

More mid-level practitioners perhaps? PAs and NPs?
 

I am a current medical student. (3rd year)
I can honestly say that the fields I won't ever touch are family medicine or Ob/Gyn.
My fiance is also a medical student and if she goes into internal.... it better be a sub-s. No way am I going to school for this long to get pushed around by this crap
 

I will be going into internal medicine, but I can't at this point see me as anything other than a specialist (cards, pulm, something)--unless of course the hospitalist route suits me.
 

Using PAs and NPs require supervision. What normally happens is a doctor who is seeing 20 patients a day also has a NP see 15 patients a day. Do you think he/she re-examines the patient, develops a differential and then does a quick uptodate search to verify his treatment is still correct. Hell no. All he/she has time for is to say, "great, thanks" and run to the next room. that system actually is much harder for the doctor and exposes him/her to more liability, while only slightly increasing his/her revnue. The NP requires another MA to bring their patients back and that much more ancillary staff for billing, calls, insurance, etc.

Anyone who has ever been treated by a NP knows it is nothing like being seen by a doctor. You hope that the NP is confident in their diagnosis, but you can tell their not.

I know financially having "extenders" looks great on the financial side of things, but to the person on the exam table, it is a lose-lose propisition.

Next solution?
b
 

they=they're
 

It will get worse before it will get better.
 

Many rural family medicine employers include loan payments in their hiring incentives. It is still possible to make a sounds financial living as a primary care physician. There are other reasons why medical students run from primary care specialties, including perception that they are less prestigious. For the most part we are trained by academic physicians who represent a different niche than private/non academic clinicians. They are generally think they made the best decision in their career choices, and often promote similar choices amongst their students. It is not just money, its also prestige...because med students don't stop being competitive once they get into med school.