Only 2 percent of medical students said they planned to enter primary care internal medicine.
Hospitalist Chris Rangel offers an interesting analogy for that grim statistic, applying the specialization phenomenon to other fields.
“Imagine if only 2% of police academy graduates took jobs as beat cops while the rest became detectives, forensic specialists, or SWAT members,” writes Dr. Rangel. “Imagine if only 2% of nursing graduates became floor RNs and the rest specialized as ICU or surgical nurses. What would happen to the US Army if only 2% of recruits became infantry while the rest were allowed to become logistics specialists? . . . It’s not that we don’t need detectives, ICU nurses, or medical specialists. It’s just that there is no advantage to having them in huge numbers. Having thousands more detectives won’t necessarily improve our ability to solve crimes better than what we have now and will be much more expensive.”
It’s something to think about, especially when we’re seeing the American College of Surgeons mobilizing to protect their turf.
Make no mistake, specialist organizations are ready to throw primary care under the bus, with the opening salvo of implying that generalist doctors can be easily replaced by mid-level providers telegraphing their intentions.
Let’s hope that the ACP is aggressive in countering these tactics. It’s becoming clear that a conciliatory approach with specialist organizations may not be feasible, and more contentious, potentially confrontational, methods may be needed to be heard above the din.
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{ 7 comments }
Odd question. Fortunately, there’s not enough residency/fellowship positions to allow 98% of medical students to enter sub-specialties.
This is like asking what if 98% of the world wanted to live in Washington DC? (for the cherry blossoms of course) As much as people may want it, it ain’t gonna happen.
I think until physicians specializing in primary care are respected by their colleagues and the organizations they work for this will not change. Everyone wants to go where the money and prestige are, and that’s not primary care. Quality primary care however, is the key to promoting wellness, preventing unnecessary and costly procedures,and diagnosing and managing serious illness if necessary. At many large medical organizations the primary care physicians aren’t even considered for the more prestigious positions. I’m not sure how to fix it, I only know it’s broken.
I’m astounded by your analysis. I don’t consider this an us versus them issue. This is an issue facing american medicine across the board. The surgical profession is facing a crisis and that crisis is already affecting hospitals in droves. This is no different than the broad crisis facing primary care. To make the statement “make no mistake, specialist organizations are ready to throw primary care under the bus” is patently false.
I honestly think that the corollary drawn by Dr. Sheldon was nothing more than a statement to build some understanding about the complexities training surgeons that differs from that of the practice of medicine. This statement was not an attack, nor was it meant to belittle the professional practice of medicine. I am saddened that it can be construed in such a manner.
I would like to make a few clear points.
1. Please look at the biographies that comprise the OPA. These men are magnificent leaders in surgery. They have literally devoted their lives to the general practice of surgery. These are not a group of super-specialists. They are icons of duty to the greatest pursuit of academic surgery. Each one of these surgeons has practiced decades in the trenches of general surgery. They are excellent men with integrity and honor.
2. To simply ascribe surgery as a “specialty” organization is akin to calling the practice of medicine a “specialty” organization. There are super-specialists in surgery for sure. However it is simply becoming impossible to be the old-school general surgeon in an era that demands perfection and complete knowledge of a field that is extraordinarily broad and deep. Society has demanded that we specialize the fields of surgery. Most of us actually would love to perform the more broad array of operation that we were trained to do, but there is little room in american medicine for us to do so.
3. There is in fact a shortage of surgeons. I’m not talking about just general surgeons (Of which I am one). But the numbers are clear. Our population is growing and aging. The number of graduating general surgeons has remained flat for over 30 years. The complexity of care is rising. These are hard facts and make no mistake, people are receiving less than optimal care because of it already. I am at a tertiary care facility. My partners and I take transfers every day from the surrounding communities. The calls from places where “we no longer have a surgeon on call” are increasing.
Now ask yourselves the honest question. What surgeon would you choose to care for your lung cancer, or your gallbladder or colon problem, or your parotid tumor, or your peripheral vascular disease?
Don’t throw surgery under the bus and deny the need for these highly trained professionals to have a voice in this issue of needing to increase the resources to meet the demand. You may just find yourself in an emergency and hear the ER doctor on the phone trying desperately to find someone out there that can help you.
JFS
“It’s becoming clear that a conciliatory approach with specialist organizations may not be feasible, and more contentious, potentially confrontational, methods may be needed to be heard above the din.”
Good plan. Just as your whole profession is about to be nationalized, start fighting with each other! I didn’t think it was possible that physicians could top the silliness of wasting all their political capital on behalf of their liability insurers with no discernible benefit to the physicians as they did with tort reform, but apparently I was wrong. Is there a more incompetent group when it comes to using their political clout in their best interest than physicians?
How about instead of fighting each other for a smaller and smaller share of the govt. pie, you work on baking a new pie?
As per Sucher. General surgery is not a “specialty” in the sense that bariatric surgery or transplant surgery are. There is no “throwing of primary care under the bus” in general surgery because, in essence, we are the primary surgical care providers of the surgical world. We’re just like you, Kevin. Dr. Sheldon’s point was to reiterate the importance of general surgeons in the community. You can’t hire a PA or a NP to do the work of a general surgeon like you can in an outpatient pediatric or FP clinic. That’s just the way it is. Drumming up a false, sensationalistic antagonism between surgical generalists and primary care providers doesn’t really accomplish anything. I’d suggest you re-think this analysis….
I agree that surgeons are not our enemies, but we do have enemies nonetheless.
In many ways, the general surgeon is more endangered, and dare I say it, less replacable than us primary care doctors. We need to identify our allies: general surgeons, ob-gyns, er docs, cognitive specialists, ie neurology, infectious disease, nephrology. Likewise, we need to identify our enemies: radiology, dermatology, surgical subspecialists (ie vascular), anesthesia (why in the world do anesthesiologists make more money than general surgeons? The guy giving you the gas is richer than the guy taking out your appendix!). Let the list grow: CMS, RVU committee, medicare, medicaid, EMTALA, private insurance.
Let the battle lines be drawn.
Robbing Peter to pay Paul? Who’s Peter? Who’s Paul? The way I see it, us “frontline” doctors have been robbed by other doctors for years. No time for crocodile tears.
A family physician
2% of students opt for primary care internal medicine. As usual, you are forgetting the 8% who opt for family medicine.
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