Medical students shun primary care for more reasons than pay

LETTER — Posted Dec. 20, 2010

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Regarding "Early years of primary care career present financial challenges"(Article, Nov. 12): Reporter Carolyne Krupa is right to mention that medical students shun primary care because of insurers' poor compensation rates.

But there are other reasons as well. Even if insurance companies were to increase primary care doctors' compensation rates, primary care doctors would still have problems surviving.

Why? Because, increasingly, much of the typical primary care doctor's life is taken up with what are known as coordinating activities. There are far too many to include in this letter, but some are: organizing all of a patient's medical care, such as arranging consultations with specialists and organizing their subsequent care; following up on laboratory and x-ray studies; setting up home care services and communicating with their nurses; and following up with patients discharged from nursing homes.

Unlike specialists who deal with a single organ, such as the heart or kidney, primary care doctors are responsible for dealing with the entire body and its psychological ills. The burden taxes even the youngest and strongest physicians. By the time one reaches his or her 60s, like me, the best survival technique is to limit one's practice so that it is manageable.

Any increase in compensation for primary care doctors would be used up paying for more assistants or nurse practitioners or physician assistants to help with the patient load.

What's the answer? Reduce and tailor the training period for primary care doctors to reflect the real life of modern medicine. Medical schools for decades have been more interested in turning out medical scientists than primary care doctors.

Good primary care doctors could be trained without undergoing the organic chemistry and calculus and physics that may be of use to specialists but which generally have little use for most primary care doctors.

Two or three years could be safely shaved off the typical primary care doctor's training before residency. This would get more of them into practice more quickly. There would be more doctors to share the load.

Paying primary care doctors more is a good idea. But for many, unless their responsibilities and workloads are reduced to manageable levels, their professional lives won't be made any easier or any more enjoyable.

They will grimly accept their fate and plod on as they have done for the past 20 years or so.

Edward J. Volpintesta, MD, Bethel, Conn.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2010/12/20/edlt1220.htm.

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