A healthy rant from the Daily Kos, which is accurate in saying that universal coverage will push primary care over a cliff:
Add a new national health insurance scheme or mandate””without addressing the dwindling supply of primary care docs””and things may quickly collapse. The pent-up demand for medical care among the uninsured and underinsured is huge. We have absolutely no reserve capacity to serve them.
Most of the essay is similar to what’s been discussed here, but the take on academic medicine caught my eye:
. . . the very culture of university hospitals and medical schools is profoundly hostile to primary care. The high priests of academic medicine are brilliant subspecialists, innovative surgeons and similar technically oriented superstars, hailed for their ability to bring research money and publicity to the medical center. Primary care by contrast is habitually denigrated and disrespected. The lip-curling sarcasm directed at the “LMD” (local medical doctor), the withering contempt for primary care in the trenches, has to be seen to be believed. Medical students “bake” for four years in this hot-house atmosphere. Small wonder so few choose primary care. Add in the vast disparity in income, and it’s a miracle anyone does.
Increasing the primary care numbers starts with respect for the work we do. Judging from what I read here, the hostility medical students have for generalist medicine starts at the very beginning.
If our colleagues don’t value primary care, how can we expect the public and politicians to?
Related posts:
- The primary care shortage in Maryland
- Op-ed: Shortage of primary care threatens health care system
- Primary care disrespect starts early in medical school
- Massachusetts learns about the primary care shortage the hard way
- How to fix the primary care shortage
- Mandating primary care
- Primary care shortage and physician recruiters
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Not to me mention the 800 pound gorilla- the fact that much (?most) primary care is provided by advanced practice nurses and PAs. Not to claim that they do it as thoroughly or as well, just that it is. That is not what most people go to medical school to do. The relatively low reimbursement just seem to make sense under these circumstances.
Sorry, but “academia” is innocent of the medical Luddites allegations.
The basic problem is that medical students are (generally) not as stupid as the single payer totalitarians would like. They observe NPs, Medicaid, Medicare and the corrupt lawyer industry.
The medical students simply are making decisions based upon obvious facts of life.
I’m a canadian doing internal medicine residency. When I asked my parents (who still live in canada) what I should specialize in, they said “Be a family doctor- they are the most important ones, right?” They sincerely meant it, bc they see their PCP as their main dr, and the specialists as the consultants…but if you ask an avg american who their dr is, they are confused and often ask “who do you mean?” bc they often have a PCP and 6 specialists, all separately dictating care…in canada, there are strict quotas to ensure a healthy number of med students enter a primary care field. But with the free for all in the US, it is definately difficult to choose PC when you see NPs setting up their practices out of CVS.
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