Primary Care…

Well, I am not even an applicant at this point, but because of my current profession, I do get daily/weekly emails about topics pertinent to my research. If I ever get accepted to medical school, I can see myself in primary care. And the fact that you can add to training in Family Medicine (for example, by electing to spend more time in OB/GYN), makes it that much more attractive.

Any family medicine residents or attending, could you please share your experiences?


I fall into that category (FM attending) so will try to speak to this.

You can sub-specialize in Family Med. Right now there are several tracks; sports medicine is the most popular. Other fellowships include adolescent medicine, faculty development, geriatrics, international medicine, obstetrics, preventive medicine, rural medicine and palliative care. Most are one year beyond the 3 year general residency.

I just got home from the AAFP Residency Program Director’s Workshop (in fact went there directly from the OPM conference) and the keynote speakers from our various governing bodies pretty much echoed what was in the article you linked. FM and primary care in general are becoming more popular and there are a number of reasons: first is the idea that we will be on more equal footing with specialties in terms of income. If the red tape can be worked out, we can anticipate that things like preventive care and time spent educating patients will become reimbursable. This represents a sea change from the old system, which rewards bad behavior and irresponsibility (my opinion). A second, but related idea, is that fees for service will be leveled out. Right now a dermatologist gets reimbursed about 3 times as much as me for taking off the same mole. Hopefully that type of disparity will go away under the proposed changes.

Another reason is the anticipated physician shortage and push toward getting the public into patient centered medical homes (PCMHs). The criteria for a practice to obtain PCMH status is very rigorous, but worth it both for patients and physicians. Patients have better access to their providers and the providers have more time to spend with their patients. Sadly, this does not bode well for the traditional solo practitioner or 2-physician practice. The administration costs will probably force many of these docs into large, institutionalized practices. A lot of people who find themselves in this situation are opting to retire early, rather than invest money to comply or sell out to hospitals or other institutions (i.e. adding to the shortage).

Finally, and again this is just my opinion, as US medical schools expand while residency programs lag behind, more students choose primary care because they cannot compete for highly-sought specialties. As the article stated, the numbers and quality of students applying to family medicine this past year were unprecedented. Non-traditional premeds really need to be taking this into account as you strategize your path to med school, weighing things like whether or not to consider off-shore schools. That’s for another post, and I’ll get into all that in a couple of weeks or so when I have some time to sort through some of this stuff I got at the AAFP conference.

Anyway…glad you are giving primary care a thought. We need you. I’ve never regretted my decision to become a family doc, even in these uncertain times.

It’s really interesting to hear so many different perspectives on this. Working for a national hospital company, I recently heard a recruitment director talking about our struggle to find PC physicians these days, and how there’s a general consensus that we’ll see a continuing decline in internal med residents who don’t go on to sub-specialize. On the employment side of things, they’ve shared that many of the PC shortage stats don’t take into account the mid level providers. As more and more primary care work is done by NPs and PAs these days, it’s important to make sure that statistics account for their work when considering the primary care shortage.

As with any major argument, I’m sure there are important points on both sides of the picture…and the next few years will be pretty revealing as trends in managed care play out. It’s definitely something I will keep my eye on through my last years on the corporate side of hospital work, and will watch even more carefully as I enter medical school.

Keep the input coming–it’s truly interesting to hear everyone’s perspective!!!

I’m leaning towards Primary Care/Family Medicine because I feel like this is an area that has the greatest potential for preventative medicine in peoples lives.

I’ve been reading Dr. Pamela Grim’s book “Just here trying to save a few lives,” and I was struck by how much of her work as an ER doctor could have been prevented by good Primary care earlier on. Like the overweight woman who came in with mild chest pains who was sure everything was fine and just wanted it confirmed who suddenly had a massive heart attack while they were discussing admitting her for tests, or the young crack addict who went into preterm labour in the ER.

These people might have had better outcomes if there had been intervention earlier on. I know that is a big ‘might.’ But I’d like to try.

It is said that th specialist, as he progresses in his career, knows more and more about less and less, until ultimately he knows everything there is about nothing at all. The generalist on the other hand, knows less and less about more and more until he ultimately knows nothing about everything.

I am definately the later by choice, and loving it.

I love the challenge of moving from colds to hypertension to back pain to irregular menses to high cholesterol to depression and back to colds

I love trying to balance the medical science with the social reality for the people I care for.

I love the continuity that comes with primary care -

If that is how you think it is the place to be.

other pluses: you can go almost ANYWHERE -

minuses: pay while still respectable - is not as good as the specialities, and you do not have as much opportunity to delve deeply into one focused area -

FP in NH and loving it

Thanks for those inspirational thoughts! That is indeed what I want to do. I can picture those different people with their varying illnesses coming in. Always felt drawn to being a “generalist”.