The future of primary care: Optimistic or misguided?

The majority of medical students in this forum feel positive about primary care, voting for this answer:

There is a future. Shortages will drive PCP salaries up and the field will remain alive and kickin’.

Comments

Anonymous
Speaking as a med student, I can also point out that medical students who are wild for primary care tend to either be hopelessly naive as to the workings of the real world, never having left their lives of champagne socialism or they’re born-again hippies returning to school after years paying off old school loans, building a small nest egg, and getting married to someone willing to support them through med school and cover the finances for years to come.
Off the top of my head, the prominent figures from our family med interest group: A hippie who, in PBL, proudly proclaimed his ignorance of PCP compensation, claiming it didn’t matter because he was in it for the love of the thing; a former investment banker looking to save his soul; a former accounting auditor from one of the big firms who ‘got bored’ one day and thought family med and giving away free care ‘looked fun’; a girl going to school on the Army dime who is the only one of the lot to know what’s up: she plans on putting in her 4 years and then working 1/2 time and being supported by a husband in finance; and the chair of this rag-tag group is another granola muncher who has trouble balancing her checkbook – I can’t wait to see her practice crumble under the burden of debt and employees who want to be paid with real money, not IOUs.
DJS
I agree. But what is the appropriate role for primary care? The current system of financing(insurance/guvmint) does not encourage the consumer to be wise, or the provider to be purpose driven. If the purpose is “ease pain” then prescribe narcotics until they stop breathing. If the purpose is relieve depression start down the lists of meds until you come to the atypicals…Anxiety, ditto. There is little motivation in the market system or the medical culture to truly change behavior or affect healing. And market forces do not affect this. Markets influence adaptations to pressures(cost-desirablity) but do not in themselves set the direction or the purpose. That needs to come from somewhere else.
EG Henry Ford believed that every one should have a car, not just the rich. Bill Gates believed that there should be a computer in every home.
So what does American Medicine believe? That we should always be without pain, depression, anxiety, suffering? I think, after 17 years of Family Medicine, that doctors are no different than the general American public, that is, “I’m in this for me”. And the first cynical post supports that. There is nothing wrong with self interest.It is fundamental. It just doesn’t lead us anywhere. And the American Medical system needs some leadership. We all do.
Anonymous
“Speaking as a med student”: I have to admit I had the best laugh of the day reading your post.
Your classmates sound just like mine back in the 80′s. I was he youngest member of the class and one of the few not interested in family practice. This was a time when the mandate of medical education was to produce more family docs as it was believed there were too many specialists.
Most of the other students were much older but not wiser, well-intentioned but ill-equipped for the real world. A few had been other things; nurses, lawyers, pharmacists and such. “Live simply so that others may simply live” read one bumper sticker. Many were AMSA members. Clogging and contra dancing were popular social activities.
Idealism was alive and well. Naivity rampant. At least it didn’t cost as much to go to school then, and there was opportunity when you graduated, even in family practice.

The future of primary care: Optimistic or misguided?

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