Favorite Quotes
"For every complex problem, there is a solution that is simple, neat, and wrong." - HL Mencken
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"I hear and I forget. I see and I remember. I do and I understand." - Confucius
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"The good physician treats the disease; the great physician treats the patient who has the disease" - Sir William Osler
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" The best test of a person's character is how he or she treats those with less power." - Bob Sutton
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"Those are my principles, and if you don't like them - well, I have others." - Groucho Marx
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"The difference between genius and stupidity is that genius has its limits." - Albert Einstein
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"It is hard enough to remember my opinions, without also remembering my reasons for them" - Friedrich Nietzsche
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"Anyone can make the simple complicated. Creativity is making the complicated simple." - Charles Mingus
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"Not everything that can be counted counts, and not everything that counts can be counted." - Albert Einstein
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"A foolish consistency is the hobgoblin of little minds, adored by little statesman and philosophers and divines. With consistency a great soul has simply nothing to do." - Ralph Waldo Emerson
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"This ain't no party, this ain't no disco, this ain't no fooling around." - Talking Heads, Life During Wartime
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"What is hateful to you, do not do to your neighbour. This is the whole Torah; all the rest is commentary. Go and learn it." - Hillel, Talmud, Shabbath 31a
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"You will never understand bureaucracies until you understand that for bureaucrats procedure is everything and outcomes are nothing." - Thomas Sowell
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"An idealist is one who, on noticing that a rose smells better than a cabbage, concludes that it will also make better soup." - HL Mencken
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"If you only have a hammer, you tend to see every problem as a nail." - Abraham Maslow
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"A great teacher is one who realizes that he himself is also a student and whose goal is not to dictate the answers, but to stimulate his students creativity enough so that they go out and find the answers themselves." - Herbie Hancock
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"There are no facts, only interpretations." - Nietzsche
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"An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you do know and what you don't." - Anatole France
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"In character, in manner, in style, in all things, the supreme excellence is simplicity." - Henry Wadsworth Longfellow ====
Nov - 15
Dec - 19
Jan - 21
Feb - 7
Mar -
It’s the job – the only solution to primary care
28 Jan2010
In my day job and my organization work I hear cries to increase the production of primary care physicians. Internists decry the small numbers of residency graduates who join primary care practices. Family physicians blame everyone for the meager interest in family medicine residencies.
Increasing numbers of internal medicine graduates, and now family medicine graduates, are taking hospitalist jobs. Internal medicine graduates enter subspecialty training in droves.
Many well meaning internists blame the training programs. This line of reasoning blames the clinic experience contrasted with the hospital experience as the reason the residents no longer choose primary care jobs. If we could just give the residents a better primary care experience, then they would rush to primary care jobs.
Family physicians blame the medical schools for discouraging students from choosing family medicine. They point out true observations – the hidden curriculum against primary care and the snobbery of academic subspecialists.
But all these sincere critics miss the main point. The job has deteriorated.
Could we produce more primary care physicians? Possibly we could trick a few more graduates to taking primary care jobs, but we would still have an ongoing stampede away from primary care. Many internists leave their practices to take hospitalist jobs. They make more money, have more predictable hours, and have decreased hassles in their new jobs.
Primary care is a wonderful noble calling. I did primary care for 20 years. The job deteriorated over time.
The patient centered medical home is a bold attempt at reinventing the job. Retainer medicine is a successful attempt at reinventing the job. Cash only practices are another successful option.
Until we (society) willingly pay our valuable front line physicians a fair wage, without excessive administrative hassles, we will have too few good primary care physicians.
The problem is one of value. We who have done primary care and work with excellent primary care physicians understand their value. I do not think the insurers understand. I am sure that the politicians do not understand.
They do not understand the complexity of the job. They do not understand the value proposition, that is how greatly excellent primary care physicians improve health at lower cost. They think that non-physicians can do the job because they have no respect for primary care.
We must do everything we can to fix the job. If we fix the job, we will have full residencies, and hospitalists leaving their jobs to come back to primary care. To paraphrase James Carville, "it's the job, stupid".
Related posts:
- Dazed and Confused – Levels of primary care?
- Does IM training lead to decrease primary care selection?
- Catch-22 – what the NY Times op-ed missed
- The semantics of primary care
- In which I respond to angry comments
Related posts brought to you by Yet Another Related Posts Plugin.
- In: Medical Rants
7 Responses to It’s the job – the only solution to primary care
Vishal Mandge
January 28th, 2010 at 11:53 am
I agree. PCPs manage 4-7 Chronic medical problems each visit as opposed to specialists who manage 1-3 problems, and still get paid less!
Patients come to me asking for referral to Endocrinologist for treating simple Type II DM with out complication! And when asked that a PCP can manage this, they tell that don't worry I have Insurance and I deserve a better care!
When a medical student tells someone that he wants to be a family physician or a general internists, he/she would look at him like he is dumb and did not get into a subspeciality! That thought process needs to be changed, otherwise our health care debt will keep on going up…
pcb
January 28th, 2010 at 1:42 pm
I agree, but think we're past the point of no return. There is a growing belief (right or wrong) that midlevels can do most of the work at the primary care level. I'm seeing more of them practicing pseudoindependently with minimal oversight from an MD who is usually overworked with their own patients (if they're even around at all.)
As midlevels increase their numbers, rotating medical students will be increasingly exposed to this "supervisory model" and realize that, most of the time, the midlevels are doing the same thing as the doctor.
Good luck getting medical students to choose primary care when their education, debt, experience, and sacrifice are valued at the same level as a non-physician provider.
#1 Dinosaur
January 28th, 2010 at 2:34 pm
Hear, hear!
Grand Rounds Vol 6, No. 19 | A Groundhog's Perspective on Med Blogs | More iPad
February 1st, 2010 at 11:06 pm
[...] of my faves is from Dr. Robert Centor, who’s a smart dude (so I am told). He discusses the reason nobody is choosing primary care: it’s not because of what people say about it, it’s the job itself. I think he is [...]
Ed Pullen
February 1st, 2010 at 11:53 pm
Well said. I still like my job as as private practice FP most days, but the constant pressure to put up "numbers" every day of not only not get paid but because overhead goes on literally lose money is enough to make anyone consider taking just a salaried position for a big company (health care system) and retire as soon as possible.
Hospitalist Jobs
February 5th, 2010 at 4:50 pm
I am disappointed to say that I think that the politicians are going to be interfering for some time to come.
Nicholas Fogelson
February 18th, 2010 at 3:25 pm
Here’s to those who still fight it out in primary care… I know I couldn’t do it. I have a hard enough time keeping my narrow field straight, trying to know something about everything would drive me insane. To not be paid well to do it would drive me to retirement.