This medical student thinks so – Enough whining about primary care

I’m not trying to present this as a comprehensive look at the data. But it is representative. I stand by my claim that the sum of the evidence favors the conclusion that medical students are largely not picking their specialty based on their debt load.

I have spent 30 years teaching medical students.  I have advised them and counseled them.  Most medical students will admit that money is a major factor in choosing a medical specialty, but not on a survey.

But the real problem is related to money, even though our idealistic student does not completely understand.

That’s certainly true for me. I came to medical school thinking I wanted to enter a field where I could work with my hands. But any thought of primary care died when I entered my clinical years in medical school. In my experience, I met only one happy primary care physician. If I were to listen to all the primary care physicians I know, or who I read in journals and online, I would think it was the apocalypse for primary care.

You must ask why primary care physicians are unhappy with primary care.  The big problems are time and paperwork.  They do not have enough time to spend with each patient, because of the financial structure of care.  They have to spend too much time on paperwork, because of the financial structure of care.

Physicians generally like caring for patients (or they choose radiology, pathology or perhaps ER medicine.)  They do not want to shortchange the time they spend with patients.  Our financial structure has the greatest negative impact on primary care physicians.

Primary care physicians are the oppressed.

Disclaimer: I have done primary care and now only do hospital medicine.  As I gave up my outpatient practice, the paperwork and time constraints were becoming onerous.

I teach primary care residents.  They love their patients.  They love medicine.  But I know that many of them we reassess their career, because primary care physicians cannot practice they way they should or they way they desire.

I do not think I am whining.  I look objectively at our health care system, and believe that more primary care physicians would improve the patient health.  I ask how we should modify our system to encourage the growth of primary care.  Money does matter.  To think otherwise is unfortunately wrong.