Primary Care vs. Specialist

The rising epidemics of obesity and diabetes, specially in children, is the first and foremost challenge of the current and future practicing physicians.

Unfortunately, our broken health care system has fueled these problems to the extent that preventive measures are needed to be taken as soon as today. One of the significant solutions to the challenge would be to train quality health professionals and primary care doctors.

The problem becomes even more exacerbated by the fact that insurance reimbursements to primary care doctors are on the decline, while most medical students graduate with ~$200,000 in loans. Since primary care is poorly reimbursed, many physicians are shunted into procedure oriented specialties like cardiovascular or GI, etc.  These docs end-up treating the many downstream heath consequences of diseases like obesity and diabetes, but at the expense of losing front-line workers (primary care doctors) that can more effectively prevent the long term consequences.

Ultimately, the combination of problems like obesity and a

failed health insurance system snowball and lead to serious

consequences for providing care.

Primary Care vs. Specialist

The way our society is going and following the health trends across the world, it is absolutely necessary to have specialists.  There has been huge advancements in technology that has allowed medicine to go to high levels of care and treatment. I feel like many medical students are leaning towards specializing because it is almost necessary to maintain that high status and prestige that was associated with being a doctor.  Now a days, some nurses, PA’s, or Nurse Practioners can make the same amount of money as a Pediatrician or Primary Care Provider.  In most cases, the nurses, PA’s, and NP are working less hours and have less stress. So I totally understand the whole trend that medical students are specializing. Sometimes, I feel like some medical students believe just being a Primary Care Physician is not enough (in our society), it is just being an average doctor.  I mean, when you think about it, most people who enter medical school…they just don’t want to be average.

While I do think that there is a high demand for specialist,  I also feel like there is also a huge demand for Primary Care Physicians.  I also feel like Primary Care Physicians do need to screen their patients more and improve the way patients are receiving care.  I understand that a huge barrier to this is the current health care system, but we are finding that a lot of illness can be prevented with appropriate screenings and education that could possibly be provided by a primary care doctor. More people will see a primary care physician than a specialist because that is the way our health care system works.  So what we really need right now is a lot of really dedicated primary care physicians who will be willing to educate and screen their patients.  But again,  insurance companies expect doctors to only spend like what..ten minutes per patient?  I think to really get medical students to want to choose to become a primary care physician, we really need to fix our health care system and make changes that allow for better primary and preventive care. 

who better to ask than future med students?

To answer this blog I decided to take some time out of my friends who are currently in med school. I know they are busy so I would like to give a shot out to them. Here is the jist of what J had to say: -health care is partly failing beacuse of this choice to specialize, -pay in primary is low comparitively, -that is where system breaks down (lack of financial incentive), -get more students to practice prev/primary(try to give more incentive by help paying off loans by working in rural areas-->Obama's plan?), -aslo, stigma that is associated with PCP (more specialized are held in higher regards not only amongst physicains, but also general public). Here is what A had to say: -pathology is adavnce (more interesting to be involved with) and compensation is more vs. less interesting (in terms of use of knowledged and training) and lower compensation, -give genearlist more atonomy in making decisions and also allow more basic procedures, -there is an issue with payment based on time vs. procedures (PCP paid based on visits and time)

Some additional notes:

-pay per performance-->issue with patient compliance, genetic, SES, etc.--> to many factors to control/are out hands of PCP

-prevention=less need for specialist-->PCP visits should include more interaction w/ other health professionals (bring up example of Lung Transplant Team)

-policy should not only attack who is paying for services (gov, people, both), but should focus on what exactly is being paid for

-without a doubt, PCP are VITAL and I repeat VITAL to the medical system...we can not have people self-diagnosing and referring themselves to specialist...

-also, even though I would like to believe the choice to pursue medicine specialization is an altruistic one, this is simply not the case...there are many factors that come into play such as lifestyle, compensation, stress, interests, etc.

-interesting note: I also spoke briefly w/ two of my other friends who are in medicine E and N. Out of the four, two are specializing (cardiology and undecided), one for pediatrics, and one for general medicine (PCP). Can you guess the reasons why?

Side note: End of Care? How much does US spend in comparison to other countries? This is an interesting point that can be added to our previous lectures in terms of ways in which to drive medical cost down.

Let'em Specialize!!

The rigors of medical school are quite exhausting but if physicians want to continue their education and specialize then I see why they shouldn't. After all, its a personal choice that must be made that entails further commitment and personal funding. If medical students are willing to accept those challenges then I don't see why they shouldn't be able to exercise that freedom. Yes, specialist can potentially make more money than most PCPs but then again many of these doctors have also endured the sacrifices and should be entitled the fruits of their labor.
In reading some of the previous posting there are those that oppose specialization to some degree and many echo the sentiment that there is an overabundance of specialist in our health care system. However, I would venture to say that there are not enough (good ones). The field of medicine is constantly evolving and just as we need good PCPs, we also need qualified and competent specialist to further the science.

primary care is an unattractive field

The practice of medicine has changed dramatically and the doctors of today hardly resemble the doctors of yesterday. Medical students are choosing their fields for the wrong reasons: lifestyle, liability, and leisure (earning potential). "Lifestyle" fields are some of the most competitive residencies to get into. Unfortunately this means that our most apt medical students are going into fields that allows them to work 9-5 with weekends off and lots of money. It's unfortunate that some medical students work hard to be at the top of their class and then become dermatologists (which Jerry Seinfeld so poignantly referred to as "pimple popper MD"). 

Primary care is no easy field. Primary care doctors work grueling hours, do not get paid well, and are subject to liability if they miss anything. There is a severe shortage of primary care doctors in the U.S. and unfortunately part of this shortage comes from the fact that this field is not very well respected.  The US is in desperate need of more primary care doctors and thus we are forced to accept foreign medical graduates and less than stellar domestic grads into primary care residencies. This means that US medical students often feel that going into primary care is akin to accepting defeat.  This also means that the students going into primary care are often not ideal, either because they are from a foreign country and may have language and cultural shortcomings when treating American patients, or because they haven't done very well in medical school. 

The US needs more medical schools overall and more schools with a primary care emphasis. This already exists to a limited extend in D.O. programs, but these programs involve a different outlook on medicine that is not for all. Additionally D.O. programs are not yet very well established or respected. We need to de-stigmatize D.O. programs as well as start more M.D. programs with a greater emphasis on primary care. Medical school also needs to be subsidized by the government (the way it is in many foreign countries). This will allow medical students to choose a field without worrying about the 200K+ debt they have amassed in the process of becoming a doctor. 

Take Your Pick?

So... we have door #1 on the left, and door #2 on the right. Take your pick? Both have services that will have an exclusive clientele, exhibit a sense of prestige and expertise, and denote a sense of professionalism beyond the mere "basics." So where does that leave the primary care physician? The "basics" are left behind door #3. The harsh reality is that primary care physicians are lost amongst these doors. They don't have the "titles" on the back end of their names that, in a sense, almost replace their names and give them the ultimate supremacy of "specialist." This leaves a primary care physician with almost having no identity at all; no sense of self; no "real" purpose. Of course, a shortage of primary care physicians is a problem that must be addressed. Maybe tackling the notion in the education sector, within the confines of where the medical profession is taught and honed can be one solution. Using the platform of professors that create Medical Doctors to stress the importance and prestige of the primary care physician might bring some serious life support to a patient whose vital signs don't look so good.

Balance is key

As the blog says, specialization is essential to the medical field. As we begin to understand the details of certain diseases and conditions, we discover a whole new level of complexity of how they come to be and how they must be treated. Nevertheless, it is the primary care physician that must refer patients to the appropriate specialist. Without the primary care physician, specialized clinics would be crowded with self-diagnosed individuals, requesting perhaps very costly procedures, only to find that their diagnosis was wrong. Therefore, there is no question about it - there needs to be a balance.