After the latest batch of 10-minute visits with the pediatrician I am wondering why people seek to become primary care doctors. We are told that in the good old days, at least in movies, the primary care doc was a respected member of the community who knew every family. Visits with patients included catching up on family news and potentially discussions of wider topics. Today, however, the primary care doc sees so many patients per hour that he or she surely cannot learn that much about the typical family. One of the things that I like about being a flight instructor is getting to know someone through 100+ hours of interaction through a rating (might be only 50 hours of actual flying time). This pleasure would appear to be denied to a typical American family doctor.
Maybe this is already happening, but if you’re just going to see patients in short little glimpses why not become a specialist and make 2-4X the salary?
People with severe health problems aren’t the bundles of joy depicted in the movies & not the ones passing FAA fitness standards to take flying lessons. It’s probably different for someone genuinely interested in helping people, but based on 30 years of dating, there was little redemption in getting intimately involved with regular doctor visitors. In most cases, there’s little to get to know because a problem treated by a GP or a “primary care doctor” as our insurance company overloards call them, is caused by a severe mental health issue. Of course, there is value in making yourself thankful for what you have.
I think that there is in fact an under supply of primary care doctors in part because of the factors you point to, but there are also mitigating factors. Depending on the speciality, specialties may involve significantly higher up-front investment, different working conditions (i.e. longer hours, more on call time, etc.), and work which might be considered unpleasant or even more boring than primary care. For new doctors, there is uncertainty about what the future compensation structure will look like. Higher up front investment magnifies the risk associated with that uncertainty.
@Neal: For new doctors, there is uncertainty about what the future compensation structure will look like.
We’ve been hearing this since, at least, 1980.
On the other hand, a close family member doubled his income when she left primary care practice to take a management job with a large health insurance company. She’s inundated with resumes and inquires from primary care docs seeking to leave the practice of medicine to do what she’s doing.
There are a finite number of residency slots: http://jakeseliger.com/2012/10/20/why-you-should-become-a-nurse-or-physicians-assistant-instead-of-a-doctor-the-underrated-perils-of-medical-school and a shortage of them. It is better to take a primary care slot than it is to sit out for a year or more hoping for a specialty slots. Specialty spots also tend to be more competitive in terms of Step 1 and Step 2 scores, so some will be limited by test scores.
It used to be that primary care folks spent less time on residencies and internships. So becoming a gp was a good option if you got tired of school and no/low pay. Short term optimization over long term.
Also, some folks try it out during need school and just love it…
People don’t generally want to be primary care doctors in the US. That’s why it’s easier to get accepted into primary care residencies.
There isn’t even a Family Medicine training program at the local (large) medical school here.
My wife always wanted to be a GP (and is now) and had no desire to work for any longer than absolutely necessary in large hospitals. She does get to know some of her patients quite well. This is good with some, not so great with others. Her main motivation was to not have to work weird shifts and to see a wide variety of cases. She also books only 4 patients per hour or fewer depending on the procedures she is doing. Note that this is Australia and despite how many US medical students I teach, I have no idea if being a GP here can really compare with being a primary care doc in the Us. Is a paediatrician a primary care doc there?
Matt: As far as I know, a pedi is a primary care doc. Seeing 4 patients per hour means 15 minutes per patient to (a) examine the patient, (b) write up notes about the patient to be inserted by the $200 million Epic system into the 1960s non-relational database management system, (c) walk from one exam room to the next, (d) check text or email queries regarding any other patients, and (e) look up any necessary information regarding a patient’s symptoms or drugs to be prescribed.
Yup. A Pediatrician in the USA sounds like a primary care doctor (http://www.webmd.com/baby/what-is-a-pediatrician) while here they are specialists (http://m.raisingchildren.net.au/articles/paediatrician_d.html) (the spelling just being one of those silly differences in the English language). Note also that here almost everything is done with the patient in the room as you cannot charge Medicare (which is for nearly everyone) unless the patient is in the room. Patients undressing behind a curtain for an examination is valuable googling time…