Tuesday, August 14, 2007

BLOGSCAN - Why Medical Students Don't Like Primary Care

On the Over My Med Body blog, this post explains with brilliant simplicity one reason why medical students choose a variety of specialties over primary care: in specialty clinics, the students can spend enough time with each patient to both comprehend what is going on, and actually learn something. In primary care, the pace is too rapid to think or to learn. The real question is why our health care system requires primary care doctors to spend less and less time with individual patients. One immediate reason is a perverse reimbursement system that pays physicians per visit or procedure, and does not pay enough for office visits to allow primary care physicians to spend enough time to properly take care of patients. See our posts here and here.

1 comment:

pam said...

You are so right. I'm a family doc who took time off for heavy family responsibilities and am now wanting to go back to work. The environment in which I can practice my skills as a communicator, healer, educator of patients, manager of problems, etc has become toxic, antagonistic toward its nominal aim.

When I left medicine, 5 years ago, I had a thriving solo practice and yet was having trouble getting paid and in turn paying off the bank. Looking at the field now I see all of the same problems (many of them worse) as when I left.

I would hate to discourage an intelligent, idealistic, empathic young person from going into primary care. But the road has become too treacherous.

As for me, I don't know whether to open a boutique practice in my upscale town or do a fellowship leading to specialization, or what. I know I can't practice medicine in the way it's currently prescribed. (I suppose that makes me "noncompliant" in the parlance of the field, though I've caught wind that the new word is "nonadherent." Whatever.)

The root of the problem is political, as you've described in your other posts. As Kevin Grumbach noted in a speech to the Society of Teachers of Family Medicine this year,

". . . fees are not the product of free-market supply and demand. Rather, they are the result of a mechanism for determining relative value units for physician services—which in turn determine fees for Medicare and other third party payers --that is largely controlled by a committee under the auspices of the American Medical Association. . . .

This committee has 26 voting physician members nominated by specialty societies; only 3 of these members are primary care physicians.
In addition to exerting disproportionate influence over policies such as Medicare fee updates, specialists have the added advantage of having much of their practice costs subsidized."

As they say, go and read the whole thing (or listen to it on your iPod.)


Thank you for your blog. We live in a relatively dark time and yours is a voice of light.