Tsivya Devereaux
M2, University of Utah School of Medicine
“We need more physicians in primary care.” I hear this on a regular basis as a second-year medical student at the University of Utah School of Medicine. There is a recognized shortage[1] of primary care physicians [2](PCP) in the United States, especially in medically underserved[3] and rural[4] areas. What is being done to get more medical students in primary care?
First, we have to look at what the PCP does. The role of a PCP is broad and unrelenting. PCPs are often the first interaction a person has with the medical system. Considering the standard allotted time for a PCP is a 15 minute time slot with the patient, there is no possible way to effectively perform annual check ups and routine screenings, diagnose and treat illnesses, bring together information from any other involved specialists as well as counsel on lifestyle changes to prevent diseases. Equally important is making sure the patient feels heard, comfortable, respected so that they come back to the provider, maintain a patient-physician relationship, and receive consistent healthcare- all while documenting in the electronic medical record. While the inclusion of Physician Associates (PAs) and Nurse Practitioners (NPs) has helped decrease the number of patients the PCP sees, it also changes the physician’s role to more administrative tasks. In some instances, there are PCPs that take on the role of a supervisor; rather than actively seeing patients, the physician supervisor is liable in the care of hundreds of patients that PAs and NPs see. In this role[5], the physician loses direct communication with the patient. Common practice has PCPs taking their work home, spending the evening hours writing notes on patients, catching up on the charting that couldn’t get done during the day. This amounts to hours of unpaid work. Every medical student approaches this differently. I am looking to work directly with my patients, not be in charge of other medical professionals.
While income isn’t the end all in the decision to practice a certain specialty, the rising cost of medical school loans is a hefty sum that is hard to ignore. While there are limited loan repayment options for residents and medical students who chose primary care in rural and underserved[6] areas, PCPs are still making on average 100K[7] less than their sub-specialist counterparts. Our healthcare system monetarily rewards physicians for procedures, tests, and imaging (easily billable items) rather than their time, expertise, diagnosis, and opinions. PCPs perform fewer procedures than many medical specialties but spend more time with patients to come to a diagnosis or be able to refer to the proper specialty, where the procedure may be necessary. In other words, disbursement is based on the more tangible parts of medical care (tests, procedures, easily billable items) and the heart of medicine and the role of a PCP; establishing a relationship with the patient so proper care can be provided is not justly rewarded. There are many more aspects to improving a PCPs quality of life and quality of care, but income shouldn’t be excluded from that conversation.
As a medical student deciding what specialty to go into, there are a few things I find important to making my decision. I’ve already mentioned my desire to work directly with patients. Part of this decision is simply what is the most interesting to me, where I feel comfortable yet challenged, and where I feel helpful and useful. In class, I listen to the expertise of my professors, many of whom are MDs, but not a single one is a PCP. There are often misconceptions, stereotypes, and generally negative opinions of PCPs from the medical school and from classmates. I’ve heard phrases such as “you’re too smart to go into primary care” or “you don’t want to just do primary care, do you?” and others that put down this incredibly demanding specialty that requires a substantial knowledge of all body systems. Even calling primary care a specialty is not well recognized. On top of this, when working with current PCPs their negative outlook can be a substantial deterrent to picking primary care. I want to see current PCPs being treated better, being included more in the medical school, and being paid in accordance to their knowledge and expertise. When I pick my specialty, I want to put my patients needs first but in order to that the medical system needs to put primary care first.
Citations:
“New Report Confirms Growing Shortage of Primary Care Physicians.” Primary Care Collaborative, Association of American Medical Colleges, 10 July 2020, https://www.pcpcc.org/2020/07/10/new-report-confirms-growing-shortage-primary-care-physicians.
“AAMC Report Reinforces Mounting Physician Shortage.” AAMC, 11 June 2021, https://www.aamc.org/news-insights/press-releases/aamc-report-reinforces-mounting-physician-shortage.
Diaz, Adrian, et al. “The Covid-19 Pandemic and Rural Hospitals-Adding Insult to Injury: Health Affairs Forefront.” Health Affairs, 3 May 2020, https://www.healthaffairs.org/do/10.1377/forefront.20200429.583513/full/.
Gdiesing. “5 Strategies Rural Hospitals Are Using to Bolster Their Workforce: AHA News.” American Hospital Association | AHA News, https://www.aha.org/news/insights-and-analysis/2019-03-05-5-strategies-rural-hospitals-are-using-bolster-their.
Okie, Susan, et al. “The Evolving Primary Care Physician: Nejm.” New England Journal of Medicine, 5 Mar. 1970, https://www.nejm.org/doi/full/10.1056/nejmp1201526.
Rita Rubin, MA. “Support for Primary Care Clinicians in Underserved Areas.” JAMA, JAMA Network, 23 Nov. 2021, https://jamanetwork.com/journals/jama/fullarticle/2786520?resultClick=1.
Nguyen, Linda. “Why Don't More Doctors Practice in Primary Care?” Medium, 16 Mar. 2019, https://medium.com/@lindang101/why-dont-more-doctors-practice-in-primary-care-43442c9fddd1.
“Loan Forgiveness for Medical School Debt.” AAFP, 15 Nov. 2019, https://www.aafp.org/students-residents/medical-students/begin-your-medical-education/debt-management/funding-options/forgiveness.html.
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