Dear future practicing physician, choose primary care

Dear future practicing physician,

Choose primary care.  I know all around you there are pressures to choose to become a specialist.  I remember those pressures well.  In medical school, one of my favorite mentors was predicting that after I got a taste of primary care, I would “come crawling back” to him.  I still chuckle about that conversation to this day.  In residency, I remember several seminars for us built around choosing a fellowship and tips on how to prepare to apply, but barely any seminars on choosing to become a primary care doctor.

There is little mystery as to why I did not find more guidance.  Specialists have much higher reimbursements for their clinical services leading to higher wages.  I also recall there being a significant difference in the perception of the prestige of practicing primary care.  Turns out, that prestige gap has been shown in research to influence career choice.

Well, after practicing primary care for seven years now, I am here to tell you differently.  With current measures built into health reform, my partners and I started receiving bonuses this year just because we practice primary care.  I see this as a substantial development.  For decades, payment schemes have been heavily slanted in favor of procedural specialties, leaving primary care physicians to make far less than their specialist colleagues.  Now, there is recognition that primary care physicians can help better control health care spending, and if you haven’t noticed, everyone in Washington, DC wants to reduce health care spending.  This bonus, baked into the Affordable Care Act, is an acknowledgement of a problem and a sign of changes to come.

But you didn’t go into medicine just for the money.  I know you didn’t.  You chose to become a physician in order to be a healer, for the challenge of learning the science of being a doctor, and for the opportunity to make a difference.  I can’t imagine a better description of my day job.

After seven years of practicing primary care, I can’t imagine going back and choosing to become a specialist.  My days consist of solving medical mysteries, guiding my patients through managing chronic conditions, and sometimes just doing my best to provide some comfort from physical or emotional pain.  I know at the end of each day that I have touched the lives of my patients, and this had led to immense career and life satisfaction.

Chris Lillis is an internal medicine physician who blogs at Progress Notes.

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