General medicine is not sexy. Less than a fourth of the doctors in the United States are currently primary care providers like Pediatricians, Ob/Gyns, and Internists. According to a recent study published by the Journal of the American Medical Association, only 2% of medical students intend on pursuing a career in general internal medicine. So when health-care reform becomes a reality, and the 46 million uninsured men, women, and children in this country seek primary care, will there be enough general practitioners? Simple math tells me no. The solution, however, may be as easy as a makeover.
There are two main reasons medical students avoid primary practice in favor of other specialties: the paycheck and prestige. Washington can address the former, but I believe Hollywood should address the latter.
While the ‘m’ in medicine does not stand for money, the ‘f’ in family medicine does need to stand for financial reward. In his recent speech to the American Medical Association, President Obama acknowledged that “we need to rethink the cost of medical education and do more to reward medical students who choose a career as a primary-care physician.”
Family doctors spend more time talking to patients than performing procedures, but these doctors don’t get paid much to chat. According to Dr. Sameer Badlani, a professor at the University of Chicago School of Medicine, when physicians are paid on a fee-for-service basis, specialists have the opportunity to make four to five times as much as a family physician. Given the increasing debt of medical students, it is no surprise that the overwhelming majority choose to specialize.
In order to increase the supply of primary care providers and meet the anticipated demand, family physicians need to be reimbursed more for their services. Congress is looking into legislation that includes provisions for loan forgiveness and increased Medicare/Medicaid payments to primary care providers. Additionally, there have been talks of expanding the National Health Service Corps, program that utilizes scholarships and loan repayment to recruit primary care professionals to work in underserved areas.
These changes however will not occur over night. It will take time for medical equilibrium to shift towards primary care. While Washington works on these infrastructural changes, the media can work on changing dissenting attitudes towards family medicine.
Doctors, like everyone, appreciate recognition and reward. Specialization in cutting edge fields presents greater opportunities for surgery, research, development and prestige. In comparison to managing chronic conditions, these higher paid specialties just seem more…well, cool.
Although television’s primary purpose is to entertain, it also has the profound ability to inform our opinions and influence our actions. If the media can get the American public to drink more milk or get tested for STDs, why not utilize this power to change dissenting attitudes towards primary care? I consider myself a reasonable person, but I’d be lying if I said I didn’t briefly consider a life of crime after watching Ridley Scott’s, American Gangster. So why not glorify the primary care provider and make me consider that’s career path too?
In 2007, Shonda Rhymes, the creator of medical drama, Grey’s Anatomy and spin off series, Private Practice, was selected as one of Time magazine’s 100 most influential people. Her characters like neurosurgeon, Dr. Derrick Shepherd and neonatal surgeon, Dr. Addison Montgomery give surgical specialties Hollywood appeal. Popular television programs like ER and House glamorize specialists as the hero, but often forget that primary care physicians are the first line of medical defense. While saving patients from flesh eating bacteria or reattaching severed limbs is cool, preventing heart disease, the number one cause of death in this country, is cool too. If commissioned, creative executives like Rhymes could be instrumental in getting aspiring physicians to see the honor of a career in general medicine.
The shortage of generalists is not only a medical crisis but also a matter of public health and economic security. It is a crisis that needs be averted before the government can legitimately promise the 46 million uninsured men, women, and children in this country access to quality health care. Perhaps a medical series that illustrates the dramatic struggle of the primary care physician could help put this country on the path towards universal health care.
Besides, can we really afford for general medicine not to look sexy?