Why students do not elect primary care


Category : General, Medical Rants

Kevin MD has a short, accurate post on primary care – Leaders in medicine are trying to figure out how to make primary care attractive to students and residents once again

That’s all well and good, but perhaps primary care needs to appeal more to the bottom-line. It has been shown that a better lifestyle is a priority in today’s medical students, which is evident by more and more taking the R.O.A.D. to happiness. In comparison, primary care offers the pressure of seeing more patients in the setting of declining reimbursements. It doesn’t take a genius to figure out why interest in primary care is declining: doing more work for less pay isn’t the best way to sell the profession.

Understanding student decision making is not rocket science. Kevin does primary care – and he understands what our leaders apparently do not understand.

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Comments (2)

“What happened to doctors just wanting to take care of people” is the lay response to the question of incentive in doing primary care.

I’ll tell you what happened – EVERYTHING has gotten more expensive as the economy is flat, and many (if not most) have had commensurate increases in pay. EXCEPT docs in private practice – insurance reimbursements are in the toilet. Medicaid, as well as several private insurers, pays about $30-$40 to see a patient, possibly less than the cabbie gets to bring that patient to the office!

Meanwhile administrators, drug reps, and people outside of medicine with much less time & money spent on school/training, are doing fine. I would guess that plenty of NPs and PAs are netting almost as much as MDs in small (solo) practices. Ridiculous, for the difference in training.

I think the future of primary care is grim, which ultimately will affect radiology & other specialty services too, since they ALL depend on referrals from primary care.

Why don’t people choose primary care? Easy. Less pay for more work. It shows in how things are reimbursed. Procedures pay hansomly, patient care doesn’t. I can spend an hour with a Medicare patient reviewing numerous problems and get paid ~ $80 (much of which goes to overhead since it’s done in my office) or a specialist can do a scope, relocate a dislocated hip prosthesis, or replace a cataract and get paid hundreds in a fraction of the time with barely any overhead (since it’s done in the hospital). Until the thought process & overhead that goes into preventive & chronic care is reimbursed as well as the technical skills of specialists, we’ll have fewer & fewer primary care docs and more & more specialists.

I like what I do (Family Medicine), but I suffer for it financially. For me that’s ok, but not for med students these days who graduate with $200,000 in educational loans.

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