Primary care

So the big news focus today is on a few JAMA studies focusing on what regular blog readers here already know.

Not only is American primary care on life support, but the future looks grim.

To no one’s surprise, only two percent of graduating medical students plan to work in primary care internal medicine.

Money is one significant reason. Student debt is rising (to an average of $140,000), and the salary disparity between primary and specialty care is growing.

But wait, it’s not the only factor. There is also the perception amongst lifestyle-focused medical students that the bureaucratic hassles are out of control:

Current students recognize the increasing demands on internists, particularly primary care physicians, to accomplish large numbers of preventive and therapeutic interventions during short visits with chronically ill patients while also managing increasing administrative expectations.

Providing more primary care role-models in academia doesn’t seem to be much help, since they themselves are suffering from the burnout of too many patients squeezed in too short time slots. Their frustration is projected onto impressionable medical students.

The studies observe that foreign medical graduates are keeping the primary care system from collapsing, at the expense of providing care in their own countries. That is not a sustainable solution, since this pool will eventually run dry.

Neither is replacing primary care physicians with mid-level providers like NPs or PAs. Although they work well to complement physicians, their relatively shorter clinical training will drive up specialty referrals, increasing the cost of care.

Good for JAMA for getting this critical issue out into the mainstream. Let’s see if anything happens.

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