When I started medical school over four and a half years ago (I took a research year), I knew that primary care was my passion. I actually had a dream beyond medicine to be a liaison of sorts between the ivory tower of medicine and the community. Once I stepped onto the scene of my medical school, things started to change. My goals stayed the same, but I started to have a thought that I hadn’t considered prior to medical school: Could I afford to be a primary care physician? Relax. I’m not talking money; I’m talking patience. Patience, not patients.
I didn’t have a problem explaining diabetes for 27 minutes of a 15-minute appointment, but patience with my fellow health care providers was another story. It seemed that at every turn people were taking shots at primary care physicians.
On medical clerkships, one is expected to play the game. Appear affable, engaged and, above all, appeal to the egos of your higher-ups. When on neurology nothing fascinates you more than the Romberg maneuver and cranial nerve testing. While on surgery your inner heart has never yearned for anything more than a scalpel and the opportunity to see the inside of another human being with your own eyes, etc.
To be fair, playing the game can be a substantial portion of almost any profession, but I found it exhausting. I hit my threshold (which is apparently two weeks) while on the labor and delivery portion of my OB rotation. Two other medical students and I were all sitting in the resident room when an intern approached us. “What is everyone interested in? By the way, I promise it won’t affect your eval!” I may be a skeptic, but I inherently distrust disclaimers. Even when I give them myself, I believe that they are a window to suppressed bias.
“I’m still open, but I’ve really enjoyed this rotation. The idea of managing two patients during the most vulnerable part of a woman’s life is something that I find captivating,” one person replied.
“Overkill,” I thought to myself. I wasn’t mad at him for playing the game but overselling is as bad as lacking enthusiasm as far as rotations are concerned.
“I’m between surgery and OB because I love doing stuff that’s hands-on,” said my other classmate.
“Better,” I thought to myself. Keep it short and sweet. When my turn came, I knew what to say but I couldn’t.
“Family. I love general medicine and patient interaction,” I said succinctly.
“Whew,” replied the resident. “General medicine is a grind. I could never see 30 patients a day and talk about diabetes incessantly!”
Everyone else started to laugh.
If I was a different type of person, I would have laughed it off too.
“Um, I actually like patients and I don’t mind counseling them,” I retorted with enough levity to remain respectful, but there was no joke in my tone. The intern shook her head.
“You think you like counseling patients until a drug addicted junkie comes back to your office for the third time begging for pain meds,” she laughed condescendingly. My cohort chimed in.
“Some people aren’t strong enough to deal with that level of challenge. Specialty choice is definitely personality based,” I continued. I should have stopped so much earlier, but something in me wouldn’t let her trivialize the choice that I had painstakingly made concerning my life and career.
“It’s not about personality. The system is not set up to support primary care the way it should. Either you see a reasonable amount of patients and lose money, or you work your hands to the bone for people who don’t care about their own health. You don’t know yet, but it’s kind of lose-lose.”
I shrugged just as the attending was coming in to give us a lecture on various birthing complications.
There were several instances where the internal medicine residents, even those who were on the specially designated primary care track, waxed poetic about finally being able to specialize and how disorganized clinic could be.
Another time a specialist scoffed when I told him that I was interested in practicing family medicine.
“It’s still early,” he replied, “You have time.”
One resident took a more hilarious approach as he informed me, “You should do internal, so you have a way out if you want it. If you actually go into family, you’re a shoe-in for heaven, no lines for you. Unfortunately, if you do family medicine, heaven will be the only VIP list you ever make.”
I decided to do internal, not because of the aforementioned folks (I couldn’t get into OB) and could definitely be swayed. On numerous blogs and news outlets, the lack of primary care providers is commonly lamented, but lack of what one of my mentors calls the “ooh and ahh” factor and noncompetitive pay doesn’t help matters.
Is there a way to make primary care sexy?
Jennifer Udom is a medical student.
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