Should specialists be re-trained as primary care physicians?

It appears the forces are aligned to bolster the number of primary care physicians.

Increasing pay has been discussed as one solution, however, any effect from such a move won’t be seen for years to come.

Joe Paduda says we need more immediate results. Training more mid-level providers, like nurse practitioners and physician assistants, or enticing more foreign-trained doctors isn’tt the answer because they too will be drawn to specialty care, and even when including them, there still will be a significant primary care shortage.

So, how about re-training specialists to become primary care doctors?

“It would be far easier, faster, and cheaper to re-train these physicians to take on more primary care responsibilities, albeit primary care with an orientation towards their specialty,” writes Mr. Paduda.

“Would this be difficult, and expensive, and meet with strong resistance from those docs?

Absolutely. But on balance it would be much easier, and faster, than waiting at least eight years for the supply of primary care docs to begin to meet anticipated demand.”

Out-of-the-box thinking, and probably will never happen. But think about it. The primary care shortage is already forcing many specialists to provide preventive services. If they were paid more for office visits, and less for procedures, you just might see more proceduralists take on primary care responsibilities.

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  • The Happy Hospitalist

    This is good comedy.

  • Anonymous

    I am a family practitioner.
    Only an idiot would go from being a specialist to primary care.

  • Frank Drackman

    Really, how hard is it to order a Mammogram, write for a Z-pack or throw some metformin at a Type 2 diabetic…

  • Lizzie

    When I lived in NYC several years ago I would see my hematologist for matters I would normally have seen my PCP. This was at his suggestion when I asked for a PCP referral. (I had recently moved to NYC one year post-lymphoma treatment. Doc saw me for follow up care only). Not sure it would work these days – it was 22 years ago and I suppose a lot has changed in caseloads since then.

    I was young and otherwise healthy and only needed PCP care twice in 10 years. The only thing is, I never felt I was getting the full picture of my health – just the view from his perspective. Being otherwise healthy I suppose I was an easy patient to manage – but what about more complex, subtle things?

  • Carla Kakutani MD

    With the way things are currently set up, what specialists would want to do this? Also, the training would have to be carefully planned out. According to a study in the Journal of Family Practice, 1998, having a primary care physician as your personal physician led to 33% lower cost of care and better outcomes compared to using a specialist physician. It would mean teaching the thought process behind managing the undifferentiated patient, handling the interplay of mental health and physical complaints, and learning the myriad health maintenence recommendations, among other things. Without the right training you would have “primary care” without the bang for the buck real primary care provides.

  • Anonymous

    Funniest thing I’ve read in awhile. Joe is going to ask people, that generally have done a longer residency and had more training of which they have had to compete tooth and nail to get, to uproot their family amd sell their homes go back to residency. They can then graduate and restart their lives. Gee whiz, where do you get to sign up for that?
    You know what I think? There are too many health care consulting firms and people like Joe Paduda need to be sent back to school to be a botanist or airplane mechanic, since we have way too many people making money off what they think healhcare should be. Most haven’t ever done one important thing when it comes to healthcare, like I don’t know, TAKE CARE OF PATIENTS, but they sure have an opinion and sure make money off of it.

  • Anonymous

    I don’t think this is as amusing as it seems. If specialists’ reimbursements drop drastically, and/or the # of available patients for them to do procedures on goes away, what recourse will they have? Don’t think that things will continue the way they have been; it’s ostrich-like thinking.


  • Mike

    What is Frank Drackman saying? Is it sarcasm? Honestly I can’t tell.

  • Anonymous

    Frank…. and how hard is it to shove a camera up a guy’s ass or read an EKG?

  • roger

    Not only not a joke, this is already happening in China.
    ” Chinese officials are now placing greater emphasis on retraining its doctors rather than developing new residencies. ‘They want to retool people already working in the community,’ says Kushner. “

    “At the end of 1999, the Chinese Ministry of Health set ambitious targets for the development of family medicine education over the next 10 years. This included, by 2002, to retrain 1000 GPs trainers from other specialties.”

    Not saying that this is the answer for the US, but I’m sure that it will seriously be considered, as long as payment reform happens (clearly not a given).

  • Anonymous

    “meet with strong resistance from those docs?”

    Only if you try to force them. It isn’t a dictatorship yet.

    Anyway, legally, there is no need to retrain anyway and nothing in most if not all states to stop them from just doing it tomorrow other than an awareness of their own limitations and the fact that they just don’t want to.

    Most, I expect, would try to open a subway shop instead.

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