Primary care: "Second class citizens"

Almost two-thirds would not do primary care if they had to choose all over again:

“Between declining reimbursement, rising overhead, and loss of autonomy and respect, primary care physicians are feeling battered,” notes Pamela Moore, senior editor of Physicians Practice. “That makes it more crucial than ever for them to create the sort of practice they can actually enjoy.”
Only about 40 percent of primary care physicians surveyed said they would stay in primary care if they had their medical education to do over again. About 39 percent said they would become surgical or diagnostic specialists, while about 22% said they would not choose medicine as a career.

Comments

Tannus
This is not surprising, and has the potential to not only negatively influence the supply of physicians and healthcare providers, but also the quality associated with the care delivered.
Personally, I view the 39% that said they would become specialists as falling prey to the “grass is greener” untruth. The truth of the matter is that unless providers feel in control of the way they practice (adequate time spent with patients, the ability to earn a sizable financial compensation for hard work put forth, decision-making autonomy, etc.), satisfaction will be dismal as best. While the easy answer (not so easy in reality) is to specialize, this will only lead to increased satisfaction if the provider gains a newfound control over their practice, which is not necessarily the case with specialists…they are still subject to regulation, productivity standards, etc., all of which lead to dissatisfaction through lack of control.
I would suggest that the best way to feel less like a “second class citizen” as this post suggests is to find joy in the entrepreneurial (dare I say, “business”) side of healthcare, and find creative outlets through strategic planning, development of referral networks, new ways to coordinate care, and improvement of clincal outcomes through tracking, monitoring, and reporting.
Truth be told, as professionals we enjoy the problem solving nature of our jobs, whether in healthcare, business, or something altogether different. If our ability to problem solve through creativity and innovation is taken from us through legislation, litigation, or competition, none of us will find satisfaction in our work.
Tannus Quatre PT, MBA
Practice Consultant
Vantage Clinical Solutions, Inc.
http://www.VantageClinicalSolutions.com
Proud Doctor
I was trained as an Internal Medicine specialist and have always hated the term “primary care”. Once we became “PCP’s”, our training and expertise was diluted and undervalued. The advent of Hospitalist medicine was the final nail in the coffin. I agree we might fall prey to “the grass is greener” but I really think the grass IS greener in other specialties. Low pay, low respect, hard work and increased responsibility are not the way to ensure General Internal Medicine will survive. All that is missing is the final death rattle.
Anonymous
I was a primary care doc and went back and did a specialty fellowship. The grass IS greener.
Anonymous
Tannus,
You are as pretentious as your name.
You have no clue what being a primary care doctor means. You are responsible for everything that befalls a patient, but have limited control over what happens to them. And you have to exert that control in 15 minutes time so you can see 25 patients a day to pay your overhead and student loan payments.
I too went back to become a specialist. While I haven’t finished, it is clear to me that the people I work under have a much better lifestyle than internists. And get paid three times as much. The government has inadvertently forced any american medical student to avoid primary care.
b
Tannus
Anonymous,
I don’t disagree with you about the role of the primary care provider…caring for patients in an environment where regulation and diminishing reimbursement compromises one’s ability to earn an honest, rewarding living is the true, yet sad state of affairs in the U.S. I don’t agree however, that specialization is the most effective answer to this problem.
It’s not that there aren’t rewards to be found from specialty practice, higher salary included…I’m suggesting though that by itself specialization is not the answer.
You make the point that “the government has inadvertently forced any American medical student to avoid primary care.” I agree. This is exactly the point – and I do not see how sending our primary care providers back to school to specialize does anything for the 25 patients a day you were once seeing. The next round of medical school graduates will have to see 30 a day in your absence.
Unless we can feel good about what we are doing we won’t do it, and that is exactly why 60% of primary care physicians would choose another field if they had it do to over again. Our challenge should not be to abandon primary care for specialized care so physicians can make more money, but should be to make primary care (and any medical specialty) attractive and rewarding so we can effectively care for patients that need it.
I’ve dedicated my profession to doing just this, and I don’t consider my efforts or message to be anything less than mission-oriented and truthful.
Respectfully,
Tannus

Primary care: "Second class citizens"

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