Tuesday, February 17, 2009

primary care vs specialist

In today's world of medicine and technology, it is no wonder why so many medical students want to move past primary care and specialize.  There are so many new, complex diseases and aspects of the human body to be discovered that is is almost a question to some as to why they would want to remain in such a general field as PC.  However, the attraction and desire of specialties does not erase the fact that our healthcare system will always need primary care physicians.  Similarly, our advancement in cures, treatments and diagnoses is creating almost the same level of need in specialization.  So, where does this leave us?  Which is more important?
I don't think it is a matter of importance but rather one of convenience, at least in today's economic recession and busy lifestyle led by so many citizens.  Over the past few years, my work in the clinical field has given me a glimpse of what patients are looking for in terms of their health and treatment.  Surprisingly enough, there seems to be a decline in the number of adults who consider themselves "healthy" that regularly see a primary care physician just for their annual physical.  More often than not, people are only going to a doctor when they feel ill or not themselves.  Yet, still, these visits are not to their PCP (some don't even have one).  If they have a muscle strain, they call the PT or orthopedist directly.  Swollen glands, they're phoning the endocrinologist.  Although many of these specialists require a referral, so many of the patients (especially in cities) use the ER as their referral.  Whether it is because of cost, time, transportation or something else, it is becoming apparent how many adults are moving away from primary care.
However, even though it offers a possible explanation as to the recent shift in accessing care, it does not mean that the need for PCPs is any less.  I don't think it is a priority problem at the present time to implement a policy restricting the number of medical students allowed to specialize, however, it may become an issue in the future.  If and when it comes to that point, serious consideration would have to be given to limit the number of people walking away from general practice.  Perhaps it could be a system like the military-physicians put their time in primary care for a few years and then can continue on in specializing afterwards if they still so desire.  Only time will tell how serious an issue this becomes

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