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Why I’m not going into primary care

April 27, 2010

I try to read as much as I can of everything floating around the medical blogosphere.  I think the most recurrent topic I come across is why current medical students aren’t choosing to go into primary care.  It’s a great topic that relates to health care reform, making it ripe for medical bloggers to comment on relentlessly.  Probably the most often cited reason is low reimbursement for primary care (read: primary care doctors don’t make very much money).  I don’t have the hubris to deny this as a factor.  If I spend the better part of a decade in training, racking up huge debt and not making money, I do expect a certain level of income when I enter the workforce.  But I didn’t get into medicine for the money.  I don’t think any of my peers are delusional enough to get into medicine for the money.  If we were really all about the money, then we would have become investment bankers.  Wall Street pays even when you almost run the entire country into the ground, and pays far better than anything in the medical world (at least as a practicing physician).

Other often cited factors are the amount of paperwork primary care docs deal with and wrangling with insurance companies.  Now, on this point I may be a bit delusional, but I see all doctors dealing with these hassles.  Those problems seem ubiquitous in medicine.  Maybe some specialties deal with it less, but not in the perception of the average medical student.  We know paperwork, pre-approvals, yelling at insurance administrators, and dealing with other bureaucratic hassles are all part of the job.

None of these or the other often cited reasons are why I won’t go into primary care.

The simplest way to put it–primary care doesn’t live up to its promise.  Primary care is supposed to be about developing long-term relationships with patients and being with them on the front-lines of dealing with their health problems (with a healthy dose of preventative care).  Who wouldn’t want to practice medicine like that?  Unfortunately, it seems this is very rarely what happens in primary care.  Patients move.  Their insurance coverage changes.  They develop a complicated chronic condition and begin seeing a specialist as their primary care.  One of your patients is hospitalized, but their care is handed off to a hospitalist.  Another patient comes into your urgent care clinic because they work and sees your partner.  Other times you’re covering the urgent care clinic, seeing any and all patients in your practice.  Soon, you’re churning faceless patients through your practice with no personal connection to any of them.  Is that how you want to practice medicine?  Most medical students don’t.

One Comment leave one →
  1. May 20, 2010 4:14 pm

    There is no question that one of the best places to do primary care in the country is at KP Northern California. The organization is far different than the one in 1995 much the same way the world has changed during that time as well.

    Practicing at KP isn’t for everybody. To be successful doctors must be open-minded, willing to learn and change, be collegial and collaborative, and understand it’s not about us but it’s about them. The needs of the patient come first. The good news is that primary care doctors are not burdened with administrative hassles or reimbursement issues, are supported by systems that remind patients about their preventive screening tests, and are free to use their cognitive skills the way medical school and residency intended. Primary care doctors can achieve work-life balance. The comments from other colleagues on various blogs support that fact.

    KP is not perfect and certainly not right for everyone. Doctors who want to open their own practice and be their own entrepreneur won’t do well.

    Primary care doctors interested in learning more should go to
    Medical students / residents not sure what to do should feel free to email me directly at and why I believe the future is bright for primary care –

    Davis Liu, MD
    Author of Stay Healthy, Live Longer, Spend Wisely: Making Intelligent Choices in America’s Healthcare System
    Twitter: davisliumd

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