Friday, November 20, 2009

The "pain" of primary care vs. the needs of the nation


If you survey medical students who are in their clinical clerkships, most will tell you that they are not interested in primary care. Some have horrendous experiences and will eagerly describe the "painful" experience of routine outpatient practice, chronic management of diseases, social issues, demanding patients, and drug-seeking individuals who are trying to abuse the system. Is this really the world of primary care?

What will happen to primary care in the future? The vast majority of current medical students choose to pursue specialties that involve higher salaries or better lifestyles. Very few choose primary care. Even among those who choose Family Medicine, some specialize in Sports Medicine. As a result, our nation is facing a (relative) shortage of primary care physicians.

My wife is a family physician and she really enjoys her patients and her work. She still occasionally encounters a drug-seeking individual, but it's far less common where we live compared to the inner city. She also may see someone who wants her to fill out a disability form when he/she really isn't disabled.

When medical students get a positive primary care experience during their clinical rotations, some may actually seriously consider it. However, since so many medical students enter medical school with the intent of becoming a medical subspecialist, surgeon, dermatologist, or anesthesiologist, it becomes very difficult to convince them to consider the needs of the nation. How will we overcome this problem? The way I see it, we need to increase primary care compensation so that students are not discouraged by the financial burden caused by student loans. We need to improve the primary care image. Essentially, we need to remove the "pain" associated with primary care.

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