Federal Government Primary Care Initiative

By Jessica Freedman, MD, MedEdits

The Federal Government will spend $250 million dollars to increase the number of primary care providers. Read the full article in The Washington Post which summarizes where these funds will be allocated.

Medical Students Choosing Primary Care

An interesting article from the New England Journal of Medicine discusses the shortage of primary care physicians in the United States. Fewer medical students graduating from United States medical schools choose to specialize in primary care, opting for "lifestyle" specialties to earn higher incomes and to have greater control over their lives. As a result, more primary care residency positions are being filled by US and non-US citizen international medical graduates.

I find that some students base their specialty choice on average salary, perceived status and the possibility of a better work/life balance. This is a common misconception, however, that choosing to specialize in anesthesiology, radiology, emergency medicine or other "lifestyle" fields will afford a better balance.

Many women choose to specialize in pediatrics and work part time. And, while these pediatricians may not make the big bucks, they do enjoy more free time. Some of my friends and colleagues who chose other specialties are not really happier than those who chose primary care. Primary care physicians often feel they have greater control of their lives and work fewer evenings, nights, weekends and holidays. Perhaps seeking out mentors who are good role models would encourage more medical students to practice primary care.

I encourage all of my clients to consider their career choices carefully. Money should be only one part of the equation to make this choice. Hopefully health care reforms will help equalize the pay discrepancies of specialists and primary providers which may increase the number of students who choose primary care.

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Clinical Practice: A New Model

A new model of clinical practice is the subject of a very interesting article in the New York Times today. Some doctors, in an effort to provide better care for their patients, are changing the way they practice medicine. By taking matters into their own hands, doctors are decreasing their administrative costs, are able to spend more time with patients and have greater personal and professional fulfillment through the practice of medicine. The Obama administration hopes to increase pay for primary care physicians and has set aside money for the development of community health centers. But, until these reforms occur, some doctors are already embracing change.

On a purely anecdotal level, many of my friends and colleagues who practice primary care, enjoy the practice of medicine more and have a better work/life balance than those who specialize. I encourage all of my medical school applicants and residency applicants to consider careers in primary care.

The Doctor Shortage

Anyone considering a career in medicine should read today's article in the New York Times about the doctor shortage. The Obama administration's challenge is to increase the number of doctors needed to care for the millions of uninsured patients in our country and the increasing number of elderly individuals. Under Obama's plan, these people will all have coverage. Who will care for them?

One proposal is to shift Medicare payments to increase the fees paid to primary providers and decrease what is allotted to high paid specialists. Of course, the specialists are not thrilled with this idea. While working in the emergency department (ED) recently, one plastic surgeon was walking through the ED asking if we had any procedures. When I asked the surgeon why he was being so uncharacteristically aggressive, he said "Well, we are all about to be "Obamafied" which won't be good for my bottom line." Interesting perspective, huh?

The article also mentioned the motivation for medical students to pursue higher paid specialties (including subspecialties of internal medicine) because many students graduate with so much debt -- on average more than $140,000. Primary care providers are paid the least of any other physicians so greater financial incentives are needed to motivate students to choose this career path.

I encourage my clients to consider careers in primary care. While the financial incentives may not be as great, primary care physicians, in contrast to popular belief, often feel they have a better work/life balance than many of their higher paid colleagues who choose "lifestyle specialties." And, since many couples are now part of two income families, money should be less of a consideration. And when we all get "Obamified," as my plastic surgery colleague suggested, the gap between who is paid what, may narrow.

Click Here to read the article.
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Primary Care: The Better Career Choice?

A series of articles this week in the New England Journal of Medicine discusses the need for the "reinvention" of primary care. This series focuses on the training, practice, compensation and overall reform of primary care. Many American medical graduates are choosing to pursue "controllable lifestyle" fields such as anesthesiology, radiology and emergency medicine, to name a few, because of higher compensation and the perception that these fields will enable them to achieve a better work/life balance.

Interestingly, some (currently unpublished) data presented at the Association of American Medical Colleges earlier this month might change students' minds. In a survey of practicing physicians over 50, a higher percentage of primary care physicians felt they had control over their lives versus practicing physicians in the "controllable lifestyle" fields.

With attention being placed on the need for primary care reform, salaries will likely increase in the future for primary care clinicians. With the potential for better compensation combined with a healthy work/life balance and the opportunity to provide care where it is needed most, hopefully more students will explore career options in primary care.

Click Here to access the series.

I provide mentoring for medical school, residency and fellowship applicants. Visit: www.MedEdits.com.