My Concerns with Primary Care

So I don’t have a grudge against primary care.

It’s only because I’m interested in primary care that I’ve been researching more about it. The recent healthcare reform law coupled with an aging population in the United States have created a more urgent need for primary care physicians (PCPs). However, a 2008 JAMA research reported that only 2% of medical school graduates today are interested in primary care. Why is there such shortage when the need for PCPs is greater than ever?

These are my three main concerns with primary care and my hope is that through this next year I can begin to delve more into these issues and perhaps even find ways to reconcile them in my mind.

1. There is too much to know – medical knowledge is becoming exponentially greater and more complex so it is harder for a PCP to keep up with all the medical advances, tests, drugs and treatments. As a result, a specialist becomes more and more necessary and appealing for both patients who want optimal care and physicians who want to provide optimal care. However the joke goes: as a specialist you learn more and more about less and less until you know everything about nothing, and as a PCP you know less and less about more and more until you know nothing about everything.

2. Primary care is becoming more about managing rather than healing – as a so-called “gatekeeper” of medicine, a PCP spends a lot of time managing an exorbitant flow of information of a patient, such as lab tests, referrals and completion of forms. A PCP is in charge of referring patients to specialists and helps coordinate care for patients, especially if they’re suffering from multiple conditions. Indeed, “primary care physicians are no longer the all-knowing healers of a generation ago” (Lee and Mongan 2009*).

3. Expanded role for non-physicians – it seems like a lot of the work traditionally done by PCPs, such as longitudinal care of chronic illness, treatment of common colds and referrals, can also be done by nurses practitioners, physician assistants, social workers and other healthcare workers. Now these are very competent people and I don’t have anything against them. But I confess that after at least 7-8 years of training to become a doctor, I would want to do something that is “unique” to medicine.

There are more issues out there such as monetary incentives and the prestige factor, but I chose to focus on these three because money and prestige are less of a driving force for me, though I would be presumptuous to say that they play no role for me. On the flip side, here is a well-written post about the positives of being in primary care.

I welcome any comments or thoughts you may have!

* Lee, Thomas and Mongan, James. “Chaos and Organization in Health Care.” 2009.
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  1. […] personally am stoked about all of this. I wrote a post a few months ago about my concerns in primary care. In my mind, however, I see these problems less as a disincentive to go into primary care but more […]



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