Why I’m not going into primary care
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.