Medical schools don’t care about the primary care shortage

I attended a talk by the Dean of Admissions of one of the most competitive medical schools nationwide. The topic was primary care and community health. He talked at length about how not enough medical students were entering primary care. He put up some graphs showing that the most lucrative specialties tend to be the most competitive ones, with primary care among the lowest-paying and least-competitive. He said that medical schools need to be making primary care more appealing. And he talked about how, in his long tenure as Dean of Admissions, he has been steadfastly committed to selecting those applicants who are committed to becoming the next generation of leaders in primary care.


I went up to the Dean afterwards and alluded to the fact that nearly all graduates from his medical school go into medical specialties instead of primary care. Has his school considered creating a loan forgiveness program for students who pursue careers in primary care, giving them an added incentive to enter the field?

His response: “There’s no need for such a program, because I’m confident that our medical students don’t choose their specialties based on financial considerations.”

Me: “But during your talk you put up a graph showing that medical students nationwide do exactly that.”

Dean: “Our graduates have some of the lowest debt levels in the country, so financial constraints aren’t a concern.”

Me: “If financial constraints aren’t a concern, and if you’re admitting students based on their likelihood of going into primary care, then why are so many of those admitted students going into specialties? Is it because it’s difficult to predict what specialty an applicant will eventually pursue?”

Dean: “Not at all. We’re quite good at picking the right students …”

And so, this fruitless conversation dragged on for longer than it should have.

The Dean of Admissions may well care passionately about primary care—after all, he cared enough to give a talk on that topic. But his school certainly doesn’t see its mission as training primary care doctors, a notion borne out by the careers its graduates enter. And why would the school care about primary care? Primary care doctors tend not to make the big-deal research discoveries that net Nobel Prizes. They tend not to accrue the sort of wealth that would someday allow them to endow professorships. They tend not to invent new procedures and new drugs. Their work goes largely unnoticed, except by the patients they care for.

If schools truly cared about training primary care doctors, then they would reduce the financial barriers to entering primary care. They could do so by reducing tuition of those who commit to enter primary care, or by forgiving some of the loans of those students who enter primary care. In fact, some top law schools do exactly this for those students who commit to entering careers in public service or as public defenders. Some business schools do it for MBAs who work for non-profits.

But I don’t think most medical schools care, and this ambivalence rubs off on its students. It’s one of the contributors to the dearth of American medical students entering primary care.

“Reflex Hammer” is a medical student who blogs at The Reflex Hammer.

Comments are moderated before they are published. Please read the comment policy.

  • http://www.facebook.com/shirie.leng Shirie Leng

    The problem is the type of people admitted to medical school are not the type of people that do primary care. If you spend all your teens and twenties getting “A”s in molecular biology and buried in books, you are less likely to have the patience, empathy, and humanity required to be a primary care doctor. Then, if such a patient, empathetic, and human person gets into medical school, the process of rote memorization and heavy science followed by residency burns the humanity out of all but the most altruistic. This is why physician extenders like nurse practitioners can be so useful. They were trained in a different way with a different background and viewpoint. They are perfectly suited to fill the spaces medicine either cannot or will not.

    • PcpMD

      This is a nice hypothesis, but I don’t think this is true at all.

      30 years ago, medical school admissions were far more academic based than they are today. Yet the ratio of primary care to specialist was much more balanced then. Not surprisingly, there was also not a large gap between the incomes of specialists vs primary care doctors.

      For the last decade at least, medical schools have been looking for more well-rounded students. Students are also much more likely to come from other careers prior to medicine, and more likely to have non-science undergrad backgrounds.

      Yet, there is a much greater disparity between primary care pay and specialist pay. Not surprisingly, more people go into primary care today than specialty care.

      I’m sorry, but I really do think its the money.

      • Homeless

        30 years ago primary care physicians took care of their patients in the hospital, did procedures, and were able to diagnose patients with complicated issue. Now patients have 6 minutes with the doctor, get referred out for procedures or anything out of the ordinary. On top of that, no hospital care. So those academic students possible choose specialties because primary care isn’t that interesting.

        • PcpMD

          Actually, you’re quite wrong. All primary care residencies must include significant inpatient experience (usually several months of inpatient rounding, plus regular inpatient calls). Family practice, which is where the majority of new primary care grads are coming from, is quite procedure heavy, with training that includes all office procedures plus endoscopy, colposcopy, minor trauma and fracture management.

          In our own practice, I and several of my colleagues have a rich and fulfilling practice that includes:

          Inpatient hospitalist work, minor procedure clinic and a musculoskeletal clinic, academic teaching to medical students and residents (who ironically come to us specifically for procedural training), and work in the ER. This is in addition to having a sizable and busy outpatient practice that cares for people of all ages – newborns to seniors. We refer when necessary, but are able to care for a lot of problems ourselves, or phone/e-consult specialists for advice on more complex cases.

          Other primary care colleagues in my practice perform routine gynecologic and prenatal care, labor and delivery including C-sections, work as administrators shaping hospital policy, organize business strategies and run giant quality improvement programs (not the kind that just appease bean-counters. The kinds that drastically lower post-MI mortality, diabetes control, chronic pain management, etc. for several million patients) perform vasectomies, run our pre-operative clinic, outpatient psychiatric clinic, a medical weight loss program, and have organized and started a residency.

          This is all within a non-academic, private group.

          Primary care may be currently plagued by a lot of things. However, lack of variety and challenge are not among them.

          • Homeless

            Every family practice doctor in my community does not do hospital work. Most of them rely on nurse practitioners. I have several chronic conditions and in each case, I was sent to a specialist to do the real work. I once needed a punch biopsy and that was referred to a dermatologist.

            Isn’t that the reason primary care doesn’t make any money because they don’t do procedures? The dermatologist got a lot of money for that 15 minute procedure, more than a primary care physician does for talking to a patient?

          • Alison Galvan MD

            What we have found is that it is not cost effective to perform dermatologic procedures like this. It takes a lot of time to do biopsies of any sort, time that you just don’t have in a busy primary care practice. The pay is just not worth the time. And insurance companies don’t like to pay for a procedure on the same day as an office visit. They want to pay for one or the other, and it’s just not worth the effort to fight the insurance company. The insurance companies would rather that we see the pt on day one, then have them come back on another day for the biopsy. That is not very practical. Also, most of the time you will need follow up by a dermatologist (ie if the lesion is atypical or malignant, which most of the time it is) so it’s just better and more expedient to send the patient to the dermatologist in the first place. It’s kind of a bummer, because doing those procedures are fun (I know that sounds awful) and break up the monotony of the day. But from a financial stand point, it just can’t be justified.

          • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

            PCPMD, I found this comment to be very interesting especially on the care of OB patients where you mention C-sections. I didn’t think that Family Medicine doctors still did this, and that got turned over to OB/GYNs to do. May I ask is your practice in a rural or urban setting?

          • PcpMD

            Kristy,

            I work in a suburban setting in Northern California. Two of our new family doctors have worked out an agreement with the OBGYN dept. They take part in the OB call, including 1st assist in C-sections.

          • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

            PCPMD, thank you for getting back to me. The reason that I was curious about the area of your practice was because I know that I have heard that in the rural communities that PCPs do all this. I just wasn’t sure about in the urban/suburban areas because there are OB/GYNs. And I know that some would prefer to have their PCP take care of delivering their baby. It sounds to me like some are trying to go back to when a PCP could be able to do alot of the care for the patients the way they once used to. How exactly did it come to be that there are so many specialists of different kinds within the field of Medicine?

    • buzzkiller

      Shirie, The idea that we just need to find the right people is a common misconception. In truth, you have to be smart to be a doc and it is a fact of life in America that smart people, people who have lots of options, need to be well paid to do hard jobs. I agree that patience, empathy, and humanity are good, but they are not sufficient. if you can’t make a diagnosis to save your (or your patient’s) life, you might as well be a sympathetic friend. So now you’re looking for someone who is very bright and hardworking, has superb people skills, and is willing to work for much less than he or she could earn doing something else. There are people like that. We’re already found them. They’re the 10% or so of med students who go into adult primary care.

      It is not the type of people that is the problem. It’s the incentives that all med students face once they get into med school. Quite simply, it’s the money. Admit different types of folks to med school and keep the incentives the same and we’ll still have a huge shortage. Change the incentives and you won’t be able to swing a dead cat without hitting a primary care doc.

      I agree that midlevels are useful. I think there is a good chance we medicos will hand it off to them and that docs will be mainly supervisors if we’re around in the clinic at all.

  • http://rk.md/ Rishi

    Great post! Having interviewed many applicants, I’ve found the “of course I want to go into primary care” image portrayed on interview day, but MS4 match lists simply don’t match this sentiment. It’s unfortunate, but compensation certainly does play a significant role among other considerations. As Shirie noted, I too feel that this void in our healthcare system will nicely be filled by mid-level providers like NPs. Will this affect quality of care? Only time will tell.

    • Jordan

      I’m a 27 y.o. taking CC classes trying to learn what I want to do “when I grow up”. The last couple years I’ve shadowed several healthcare professionals after I discovered a deep interest in science. I’ve always known I would work with people, but unclear on what level that would be. What would you recommend to someone who is interested in primary care, but has made no decision on the path by which they would achieve such roles?

      Nutshell – Become a PCP or NP?

      Very curious/interested in any replies. Thanks

      • PcpMD

        I can only give you insight into the MD/DO career path. These are the factors that come to mind:

        1) Time: You’ll need to comlete another 4 years of medical school, plus a three year residency in order to practice primary care. Also, this is after you complete your 4 years bachelor’s, which, AFAIK, is a requirement for medical school matriculation in the U.S. This will place you somewhere in your mid-30′s by the time you begin your career.

        2) Financial cost – you will accumulate between $150,000 and $250,000 in student debt during those 4 years. You will then begin earning a small salary as a resident, but will almost certainly not be able to pay off your student loan debt until you’re an attending, deferring it (and accumulating interest) until attendinghood.

        3) Opportunity cost – you will give up the last part of your 20′s and half of your 30′s in devotion to your training. If you don’t already have a family, you will likely not begin one until after completing residency (at around 35). If you do, it’ll be harder, as you’ll have to find the time and energy for your family during these physically and emotionally taxing years. You will have very little time for travel, exercise, leisure reading and socializing. You will not begin to create a nest-egg or save for retirement until at least your mid-30′s.

        4) Its freakin’ hard! – the first two years are all about lecture halls, labs and “learning groups”, after which you spend several hours actually studying. Weekends are mostly independent study, usually 6-8 hours in the library. You’re also competing against some of the most academically talented individuals in the country.

        Following that are two more years in clinicals, often spread out over a large geographic area. Here, your schedule is at the whim of your rotation director and attendings. As an example, my first rotation as a medical student was 3 months of surgery, which involved 10 hour days each week-day, plus overnight calls every Wednesday and Saturday, with post-call rounding on Sunday. You’ll also need to be on your best behavior, as the letter of recommendations you get, and the contacts you make, will help determine your prospects after medical school

        The examinations (USMLE I, II and III) are also quite challenging. Its common for students to begin preparations 4-6 months in advance for these, usually devoting somewhere between 10 and 20 hours per week for board-prep, in addition to whatever current material they may have. Many also attend a several-thousand-dollar prep course. As the boards are curved, you have to again compete against the other students to do well enough to get into your desired residency.

        Would I personally do it all again? Yes. But its definitely something that you need to think long and hard about. The alternative, dropping out of medical school/residency (as some do) is extremely costly both financially and emotionally.

        • Jordan

          @PcpMD:disqus Thank you for your response. You answered quicker than when I asked my own PCP. Ha!

          I should have worded my question differently.

          The last couple years I’ve read articles on the same topic – primary care is going down etc. I’m aware of the NP/PA climate and how there is speculation that primary care providers will be “mid-levels”. I’m also aware of the contention that this brings; I vaguely remember a NYT article about a Nurse being called “Doctor”…

          Before I get out in left field…

          What would you say to someone (me, your nephew, next door neighbor) who is interested in Primary care? Would you recommend becoming a Doctor? Would you recommend becoming a PA? NP? I know these are vastly different professions, but from an outsider looking in I’m reading/hearing that all 3 can do the same thing. If primary care will someday be a “lost cause” (sounds too negative, but I’m naive and can’t think of a different term) for Doctors – is it a good idea to pursue medicine at a physician’s level? Should people pursue mid-level roles and save a considerable amount of money and time?

          • buzzkiller

            I’m a family doc of 23 years. If you want to do primary care, becoming a PA or NP is a lot easier and cheaper than going to med school. But remember that it’s a pretty rough job. Also, if you it, you might want to consider working in the same locale as a doc if you can. Less stressful to have immediate consultation available.

      • buzzkiller

        It kind of depends where you intend to practice and how long the career path is. You should have good employment opportunities with either career path. Here in WA state, NPs can practice independently but PAs must have some level of physician supervision. It’s different in other states. As a doctor physician supervision is a good thing for all midlevels (less stress if you have someone more knowledgeable around), but we’re talking about your career here, not my preferences. I have found no difference in overall quality between NPs and PAs.

      • ninguem

        PA is probably the best bang for the buck.

  • http://www.facebook.com/dave.james.90410 Dave James

    Income considerations definitely affect decisions on practicing primary care. And the increasing saturation of the field with para-medical practitioners (NP, PA, SA, even PT etc.) who nationally seek to practice, compete and bill independent of physician over site may be an additional factor.

  • http://twitter.com/AmitVohra_CEO Amit Vohra, CEO GPRA

    Definitely one f the big challenges facing the US health System – Australia has tackled this one quite simply – 75% of med school places are commonwealth funded which means that med students walk away with a financial debt of under 50k after med school – with gen Y demanding a more balanced lifestyle primary care is fast becoming the specialty of choice

    • http://www.facebook.com/profile.php?id=881580563 Kristy Sokoloski

      “With Gen Y demanding a more balanced lifestyle primary care is fast becoming the specialty of choice”. Interesting. How is that possible? I have read in other entries on this blog where some have said that more and more Primary Care Physicians are choosing to work either as hospitalists or in Urgent Care.

  • ted whitney

    What’s the school and what is the dean’s name?

    • http://twitter.com/TheReflexHammer Reflex Hammer

      Since I blog anonymously, I felt it would be unfair to call the Dean out by name.

      • http://www.facebook.com/people/Jason-Simpson/100001631757606 Jason Simpson

        My guess is that it is Johns Hopkins. Or if not, the dean certainly shares the same attitude as your med school. The CEO and deans at JHU made outrageous comments in the Hopkins Med magazine about a year about about how they werent interested in making primary care doctors but wanted to produce “leaders” in medicine instead. What a joke.

  • L.U.

    It’s not the front side debt (that you’re trying to solve through loan forgiveness) driving these “specialty” decisions, but rather the long term financial upside. Until the payment model is re-configured, not much will change.

    • buzzkiller

      Bingo.

  • medstudent

    Tell me something:

    Why should I pursue a primary care field? Why should I spend 4 years in med school + 3 years of residency only to become a primary care physician when the media and politicians are telling me that midlevels with a fraction of my training are equivalent to me? Logically then, why the hell should I waste my youth working my butt off to become a primary care physician? What’s the point? As there’s talk of increasing the length of FM residency from 3 to 4 years, you see NP/DNP diploma mills popping up left and right putting out “equivalent” practitioners with online degrees who will have the same scope of practice as I would if after spending 7 years in rigorous training. There’s no respect in the field (as can be seen with the watering-down of the profession). There’s relatively less money compared to other specialties. And there are more headaches to deal with as a PCP.

    It’s not the money (or lack thereof) that pushes me away from primary care. It’s current US society itself that pushes me away from primary care. I read the newspapers (when I’m not studying). I see what the nursing organizations and politicians say about how “easy” primary care is. I’m not willing to waste my time, money, and youth for someone else with a 2-year online degree to be considered equivalent to me and have the same scope of practice as me. Practicing medicine is a privilege. If it takes 7 years of rigorous training for me to be trusted to practice independently, why should someone with less than a quarter of the training I get be given that privilege so easily? So, if I’m going to work my butt off over the next (minimum) of 5 years (I’m an M2), I’d rather go into a field where my skills and knowledge are actually appreciated. That rules out primary care.

    Is there ego involved there? Sure. But it’s more that I’ve been bullied to the point where I can’t appreciate primary care. It’s beaten into my head that it’s such an easy job that people with 2-year online degrees can do it. I’m not going into hundreds of thousands of dollars in debt and 7+ years of training to do an easy job. I want a challenging job that’ll require me to think on a daily basis. It’s as simple as that.

    • buzzkiller

      Well, when you’re right you’re right, and you, young med student, are right. American society is telling you, mainly in dollars and cents, to avoid primary care like the plague. The headaches that you mention are also a big factor. A lot of med students are mortified when they follow a family doc or general internist around for a while in the clinic. The paperwork is simply unbelievable to those who have not witnessed it. “I see how you do it, but I don’t see why you do it.” Note that I write this as a family doc of 23 years. I’m sad to write it, but it’s true.

      The medical profession is slowly but surely throwing PC into the laps of those midlevels who will put up with it. They might find, as I have found, and as my current midlevels have found, that it is not as easy as it looks from the outside.

      You all need not feel guilty about not going into PC. It’s not your fault that things have come to this. It’s the country’s fault.

      In time PC might be a better job for a physician, if and when America realizes, guess what, it is a good idea to have fully qualified physicians providing or supervising the care of patients in an outpatient setting. I see little evidence that this realization is coming soon.

      • Alison Galvan MD

        I can’t agree with you more, buzzkill. I can’t believe anyone would go into medicine now. So much easier and cheaper to go to nursing school and then head on to nurse practitioner. Not just for PC either. But especially for PC. The days of the independent small group primary care practice are over. And that , in my opinion, is a very sad thing for medical care in our country.

        • eirikr1

          right on. AMA opposed NP’s going from direct supervision from, to collaboration with, a medical doctor. Now some states are allowing independant practice, no MD input period. And licensed by the Nursing board, not medical. NP’s always win because of the looming doctor shortage. what are medical schools and the AMA, doing about it?? are we opening new schools, expanding current schools and classes?? Will the AMA create it’s own mid level provider..Master Paramedic, MP’s or ARMP? No, the AMA will stand smugly superior while nursing encroaches more and more on what used to be the practice of medicine…

      • eirikr1

        Not only the unbelievable paperwork, but the unbelievable fight to justify making a decision that you were taught to make. every decision, every judgement you make that involves money is can be questioned..by an insurance doctor, UR nurse, or mere CPA trainee. Evidence and justifications will be demanded. A doctor with 8yrs training, x years residency, etc is supposed to put up with this?? Better an NP wannabe who’s just thrilled to actually be treated like a real, live doctor than a doctor wondering if this how a real live doctor should be treated….

    • http://twitter.com/BustillosMiguel Miguel Bustillos

      Dear Medstudent, humilty is one of our greatest virtues. It seems to me that you do not possess it. Have you ever taken an online course? Do you know how much work is required in those online courses? Those mid-level practitioners that you are referring to, have worked very hard to obtain their degrees, just like you. What makes you say that they worked less than you? Your tone is very condescending. It’s true, it takes you longer to get your degrees, but nurse practitioners usually have a bachelors degree in nursing, years of experience, that you do not possess, and a master’s degree, and some even PhD’s. You think that is easy? If I was sick, I am not sure I would want you to take care of me. I would be afraid your ego would supercede a life saving recommendation from a nurse practitoner. In regards to mid-level practitioners, studies have shown, that they do provide equal or even better care than PCP. I know many physicians that have no idea on how to treat certain patients, they call mid-level practitoners to help them. To me, you could have 100 years of education and if you do not know how to apply it, it means nothing. Experience always supercedes education;and usually, by the time a mid-level practitoner finishes their education they have 10 times more experience than a new physician. I wish you luck, and I also wish you used your real name, so I can avoid going to see you when you become a doctor.

      • ms3

        I have no doubt that midlevels worked hard to obtain their degrees, but humility aside, my question is whether the extra length and cost in the training required to become a PCP is worth it, compared to the work that midlevels are capable of doing. In other words, if midlevels can function as PCPs, then why would any MD choose primary care?

      • eirikr1

        If you go looking for Physicians with ego, narcissism, or personlality disorder, you will find them. But talk to nurses about ARNP attitude, and you will also be told of ego, and personalities that “earned” this/that, personalities that are not “mere” nurses anymore but blah, blah, with a masters, ARNP and XYZ. But you can add wannabe, and a need to disrespect nurses so they can appear like a real doctor, not just another azzhole physician. A physician does not need to be an ass just to prove they are a physician. (though some need to be an ass when they are not getting the respect they feel they deserve as a physician). I’m quite certain that your quote: “I would be afraid your ego would supercede a life saving recommendation from a nurse practitoner” could be easily changed to an NP not even hearing a mere RN/LPN giving “a life saving recommendation”. And that would be from a healthcare worker who is actually in the trenches doing the work, and *knows* the patient.

  • qwerty

    Reflex Hammer,

    You’re an M2. Wait till you get to the clinical years. Then you’ll see how easy it is to decide not to pursue primary care. As an M2, you don’t really have much of an idea of the variables involved in deciding what field to go into. So, refrain from making ridiculous claims about how medical schools in the US don’t care about the primary care shortage. You really don’t know what you don’t know. You’ll look back on this article a couple of years from now and laugh.

    I say this as a resident in FM. Preclinical medical students don’t understand what goes into deciding which field you want to pursue. Liking learning about something during M2 year doesn’t mean you’ll like the actual medical specialty. Don’t worry, pretty much every preclinical student makes this same mistake. Chances are, many people who enter med school with the idea of becoming a PCP will enter a non-primary care field while many people who enter med school with the idea of becoming a specialist end up in primary care.

    • http://twitter.com/TheReflexHammer Reflex Hammer

      Your condescension notwithstanding, I stand by my remarks.

      • Dr.Acula

        Wow, reflex hammer, you sound like the type of medical student who’s extremely hard to work with on rotations. You shoot down others’ experience (which is greater than yours) so easily. I’ve worked with students like you in the past and, if you don’t adjust your attitude, you will end up not getting the all-important honors on clinical rotations (keep in mind that, unlike preclinical grades, your grades during the clinical years DO matter). The fact is, you ARE an M2. At this point, you don’t know what the reality of practicing medicine is like. Clinical medicine is very, very different than sitting in a classroom learning the basic sciences. Once you’re in the hospital/clinic day-after-day, working up patients and practicing actual medicine, then you’ll develop a true understanding of what medicine is and what field you want to pursue. Liking learning about cardiovascular path/pathophys doesn’t mean that you’ll like the day-to-day practice of cardiology or that you’ll like the patient population that cardiologists work with. Again, I’ll reiterate: clinical medicine is vastly different from the preclinical years and preclinical experience shouldn’t be the driving factor (ie. the main factor) in deciding what medical field to pursue.

        For all you know, your school is picking EXACTLY the kind of students who would pursue primary care. Once you get out into rotations, however, it’s pretty easy to be discouraged from pursuing primary care. This probably has absolutely nothing to do with what your school encourages or discourages. The fact is that primary care is riddled with a lot more headaches than most other fields of medicine. Many people don’t want to deal with those headaches in the face of continually decreasing reimbursements and increasing patient volumes. There’s nothing wrong with that and it’s not the school’s fault. You’re finding a causation/correlation where none may exist.

        Also, please read more into the literature regarding the primary care shortage. Talking to my FM colleagues, it seems like there’s a large group of PCPs who make the argument that there’s no shortage — rather, it’s a problem of distribution. Too many physicians in urban areas and not enough in rural areas. I don’t know enough of this topic (I’m not in FM) to make an educated comment but, since you seem to be interested in this topic, wanted to point something if you wanted to look into it. Best of luck with the rest of M2 year and on Step 1.

  • Dr Helen Terrell

    This really is so important. We need to start the story earlier though and get knowledge about Primary Care into school- maybe with GPs delivering talks to pupils and teachers?
    Work experience seems to have died a death in the UK – it’s become very expensive for schools to pay for health and safety issues apparently.
    Birmingham University where I trained is planning a Careers fair in January and medical students will have the opportunity to do live web chats with Drs from all specialties including General Practice.

    I think most of my GP colleagues values are care and quality. They are not financially motivated. The costs and risks of running a business in the UK are very considerable and may well put some individuals off. Most of us just want to earn a fair wage that reflects the work and committment we have made to an area and our patients. Our professional costs are the same as other specialties but the personal financial risks of employing staff much higher.

    Best Wishes and a Happy New Year!

    Helen

  • http://twitter.com/BustillosMiguel Miguel Bustillos

    BTW, I am not a nurse practitioner. I’ve been in the healthcare field before you were probably born. I teach medical students like you. You obviously have no ideaa of what happens in a hospital. Most of you medical students have no idea of anything. You think because you are in medical school that you are entitle to some respect. Respect is earned. Continue reading medical journals so that you can find some accurate information.

    • ninguem

      Your credentials show as MBA and RRT.

      What exactly do you teach? Respiratory therapy?

      • eirikr1

        I’ve known many paramedics, RRT, and etc, that can teach ACLS or even ATLS. Sometimes med students, in an act of humility, will take ACLS or ATLS from the above when they could hold out and take it from fellow doctors or med students. Hey, paramedics *are* experts in ATLS, right??

        The RRT, paramedics, and etc then repay the med students humility by bragging to anyone who listens that they can even teach med students. Bustillos takes it a step further by judging his students….

  • http://twitter.com/BustillosMiguel Miguel Bustillos

    I am not a nurse practitioner. I teach medical students. Studies do exist. Google it and you will find thousands of studies showing that PCP and nurse practitoners provide comparable care. I don’t have a reason to lie to you. You can believe what you want. If you want to think you are superior, go ahead.

    • eirikr1

      yeah, studies exist; all of them by nurses or commissioned by nurses. I would be interested if any studies not by nurses exist. But why would anyone other than nurses bother commissioning such a study in the first place??

  • DBear

    There are at least partial truths sprinkled throughout most of the commentaries I have read below as well as denials of truth, people have the view they have and most are unwilling to embrace or even entertain the perspectives that do not align with their own. IT IS THE MONEY; the discussion example above demonstrates how blind some people have become to the “facts” that they present. Health care needs a major overhaul at multiple levels ranging from education to reimbursement for services, but also American culture needs a psychological overhaul.

    • Alison Galvan MD

      Bravo, DBear! Our culture is killing us.

    • eirikr1

      Bravo. You’d think the MBA in this thread would have been the first to point that out…

  • http://www.facebook.com/mike.feehan.98 Mike Feehan

    I think medical colleges are not different from other graduate schools, or undergraduate colleges for that matter–public and private – in this respect at least:

    Namely, that their chief “product” is graduates that have maximized their chances to earn significant money in their careers – - and so become alumni donors.

    Thus a medical college has a financial interest in its graduates choosing a specialty. That is similar to the financial interest any non-professional college has for its graduates. That is, both types of colleges desire to graduate individuals trained for high-income careers. Their grads then are able to give more to the college when it asks.

    And doesn’t it always ask.

  • ms3

    “One of the most competitive medical schools nationwide” probably got that status from the research funding it receives, and I would guess that most of that research funding is associated with specialties, not primary medicine. In the same way that finances determine personal decisions as you pointed out, I think finances also determine institutional decisions, including how much primary care is actually encouraged above and beyond the theoretical principles that are spouted.

  • http://twitter.com/ThirdCoastPA Matthew Edwards

    I explained this on the last attack of the midlevels thread, but it bears repeating here: “midlevels” consist of NP’s and PA’s, but they are not the same. It isn’t like comparing MD’s to DO’s. Though PA’s and NP’s often function interchangeably in some specialties, their training and scope of practice is actually quite different. I won’t go into the details of each profession’s curriculum and licensing – you can look that up yourself – but it behooves you to at least have some knowledge of what you are talking about before you start hyperventilating about midlevels taking your job. I am a PA student, which means I will soon be a midlevel, and believe me, neither I nor my colleagues are interested in practicing independently of physicians and “taking over primary care.”

    That said, I completely agree with reflex hammer’s post. I entered PA school intending to go into primary care, which was my background prior to starting school. But I found that in many subtle and not-so-subtle ways, my professors and preceptors were telling me to avoid it like the plague. Loan repayment options, even in the severely undeserved area I live in, are paltry at best. You would think, with all this talk of primary care shortages, that the government put its money where it’s mouth is and actually make it worth my while but until that happens I will run screaming to the nearest ortho doc offering me a job. It’s amazing how quickly my noble intentions go out the window whenever my FedLoan Servicing statement arrives.

  • http://www.facebook.com/profile.php?id=614010948 Earl Smith

    I did not go internal medicine chiefly because the training did not seem relevant to Primary Care. And most of the interns and residents seemed to be profoundly depressed.

  • OMS

    I would like to add, as I don’t think anyone mentioned it before, that primary care is potentially one of the worst places for midlevels to be given expanded rights. Despite the constant disparaging of family medicine it is one of the specialties that requires the largest depth and breadth of knowledge. This is where the disparity in training comes into play, because MDs/DOs who have completed an FM residency have MUCH MORE time spent in training and thus the vast array of knowledge required to do their jobs correctly. Primary care is much more than managing HTN or DM, strange pathologies walk in all the time that require a deep understanding of disease process. PCPs need more respect from people other than physicians.