How Can We Encourage Medical Students To Choose Primary Care?

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ztaw15 said:
As an extension on this, I was half-joking with someone today (after a case presentation) about how every time we have a case to go over in class it inevitably starts out with a sentence about how the primary doc screwed something up or made a misdiagnosis, etc.
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With time and reflection, I have grown to despise these sort of things. I remember spending very, very long periods of time in medical school with patients asking questions and taking extensive histories. I would ask questions from three different directions about symptoms and get the "no". I would say half the time (or more) different residents on the team would ask the same question/s in a dozen different ways and still get the same "no". Then, after my refined and extensively coached presentation to the attending, I am asked by the attending about patient's symptoms. Proudly and confidently I would answer that the patient does not have symptoms x, y, z. We go into the room and the patient completely changes their tune. If the residents aren't there to back me, when we leave the room I get the shake down and am all but accused of lying!

Now, done with residency, I do an extensive pre-op. I dictate it in the clinic exam room with the patient and family members. Then the day of surgery comes. If I am lucky, I get to pre-op and anesthesia tells me the case is cancelled because the patient has now recanted their medical history and now requires further work-up. If I am unlucky, the patient goes to OR, +/- gets through case, and has this horrendously rocky road. Family is mad. And, somewhere along the line... if I'm lucky, family and patient reveal the hidden co-morbidities that sabotaged their chance for good care! They may reveal this to a medicine consultant... whose resident then presents at conference, "DrX did this, that and the other and completely missed this diagnosis and the patient almost died!". Fortunately, if I am lucky at this point, the mature attending that actually read my dictation and anesthesias' reports and confirmed the patient's acts of deception will proceed to smack the resident down... because he/she did not bother to read the chart and is just gloating out of ignorance.
lowbudget said:
...That said, and BD chime in if you'd like, in the real world, you'll have plenty of cases where family medicine might be the 4th person seeing a patient after they've bounced around the health care system and gets the case right.

Honestly, it's nothing really to brag about. It's called: Doing your job...
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Blue Dog said:
It's almost always easier to be right when you're the second (or third, fourth, etc.) person seeing the patient... :rolleyes:
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No joke. Not really exciting to do a case presentation if the case was solved on the first go around.
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Both true. I just think it's funny, as said by the person before, that we have these "ethics" and "community" type classes where primary care is put on a pedestal and then we have these constant inferences about primary care missing things, etc. Accurate or not, I think it does have an impact on students who are already in a state where they are constantly concerned about "keeping up" and plagued by the "am I good enough to really do all this" type of questions... I mean I am pretty interested in family medicine, and it definitely makes me hesitate. Just imagine the effect that kind of thing has on students who don't even have primary care on their radar to begin with. No one wants to be lumped into the group of "incapable", and we really aren't exposed to primary docs during the first two years. M1 is all PhD's and M2 is almost exclusively specialists. Of course this makes sense; it's nice to have a neurologist giving neuro lectures and hepatologists teaching hepatology, but it does skew your view inevitably.
 
ztaw15 said:
Both true. I just think it's funny, as said by the person before, that we have these "ethics" and "community" type classes where primary care is put on a pedestal and then we have these constant inferences about primary care missing things, etc. Accurate or not, I think it does have an impact on students who are already in a state where they are constantly concerned about "keeping up" and plagued by the "am I good enough to really do all this" type of questions... I mean I am pretty interested in family medicine, and it definitely makes me hesitate. Just imagine the effect that kind of thing has on students who don't even have primary care on their radar to begin with. No one wants to be lumped into the group of "incapable", and we really aren't exposed to primary docs during the first two years. M1 is all PhD's and M2 is almost exclusively specialists. Of course this makes sense; it's nice to have a neurologist giving neuro lectures and hepatologists teaching hepatology, but it does skew your view inevitably.
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The success of a physician is rarely based on the first visit/exam/interview. When there is urgency/pain/suffering, patients will often drop their guard and modestry and tell as much as they can to get relief as quickly as possible.

However, with the chronic or insidious disease or patients who's circumstances allow for continued denial, it takes work, time, and far more intimate relationship building to get the facts needed to help the patient. It is about longterm trust building. This is the key of primary care. It is what develops the relationships that allows you to understand the nuances of what the patient tells you even when he or she is failing to actually tell what is important.
 
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ztaw15 said:
As an extension on this, I was half-joking with someone today (after a case presentation) about how every time we have a case to go over in class it inevitably starts out with a sentence about how the primary doc screwed something up or made a misdiagnosis, etc.
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For every dumb FP story there is a dumb ER, surg, or ologist story. I've been on both sides. It's really a shame. We should all be on the same team.
 
EdibleEgg said:
For every dumb FP story there is a dumb ER, surg, or ologist story. I've been on both sides. It's really a shame. We should all be on the same team.
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Ditto - the same is said for everyone across the board. It seems that the only genius in the mix is the one running his/her mouth.:idea:
 
Basically you have to love scabies, working on outpatient notes while trying to be on inpatient services and getting paid little when you're done to want to do Primary Care.

Seriously some patients/people don't deserve medical care.We're ****ing with evolution here.
 
medgrlsox21 said:
Basically you have to love scabies, working on outpatient notes while trying to be on inpatient services and getting paid little when you're done to want to do Primary Care.

Seriously some patients/people don't deserve medical care.We're ****ing with evolution here.
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Did you really just say that? Did you really just say that some people should be turned away and left to die? WTF is wrong with you? How in the hell did you get into med school??? I worked in a CHC, I would NEVER say this about the patients we saw.
 
SBB2016 said:
Did you really just say that? Did you really just say that some people should be turned away and left to die? WTF is wrong with you? How in the hell did you get into med school??? I worked in a CHC, I would NEVER say this about the patients we saw.
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Wait until you hit residency and are called every name in the book and treated worse than you could ever imagine by some of these deadbeats. You may change your tune.


That said, when i remember what it's like outside of residency, and outside of a hospital system that gives away care to ungrateful a-holes for FREE, I remember that it's an awesome privilege to be a patient's PCP. There is nothing else like it.

As for scabies, I have yet to see a case.
 
SBB2016 said:
Did you really just say that? Did you really just say that some people should be turned away and left to die? WTF is wrong with you? How in the hell did you get into med school??? I worked in a CHC, I would NEVER say this about the patients we saw.
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Did I just see Burnett's Law in action?
 
Doctor4Life1769 said:
Did I just see Burnett's Law in action?
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Absolutely not. OMG, WTF...! How could you even think that? You're obviously going to be a horrible doctor if you think that was Burnett's Law. I feel sorry for your future patients.

:p
 
medgrlsox21 said:
Basically you have to love scabies, working on outpatient notes while trying to be on inpatient services and getting paid little when you're done to want to do Primary Care.

Seriously some patients/people don't deserve medical care.We're ****ing with evolution here.
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Dx:

Axis II: future pathologist.

Prognosis: guarded.
 
To me it is the attitude that a person is not equal or deserving of care. There are jerks in this world, I have worked with them, but they are still human beings.
 
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If you want to care for someone that doesn't have any more respect for you than to spit on you, have at it.

There are plenty of people in this country that need care that are appreciative of helping hands, and I'd prefer to stick to them.

I would again be willing to bet that you will change your tune after you're carrying the tag "Doctor". I care for people plenty, but if people can't treat you with the simplest forms of human respect...sorry, but they aren't worth the time or the effort.
 
That's one reason I didn't go into EM.

In FM, I can dismiss patients who are wasting my time, which frees me up to help more patients who actually care about their health.
 
Blue Dog said:
That's one reason I didn't go into EM.

In FM, I can dismiss patients who are wasting my time, which frees me up to help more patients who actually care about their health.
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Amen. God love those who wish to do EM, but I knew long, long ago it wasn't the place for me.

Likely the only way I would ever do inpatient medicine would be if I only had to admit my patients or those of my partners (ie. no general call) for many of the same reasons.
 
SBB2016 said:
I get that, but unless we're talking about this lady http://news.yahoo.com/police-rescue...nsas-city-161117342--abc-news-topstories.html who should be locked up in Yanamayo prison, and lose all her human rights, I've been spit on by homeless people in the hospital, called names, etc... but it doesn't mean that the people don't deserve care, they probably need more...
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hey dudette.

that lady needs her health cared for too. don't be hating on her, you never know, she may need more care than you think.

just saying, if you're gonna settle up on that high horse of yours, better not let anything taint that white knight image you're spitting.
 
Whatever, why did you go into medicine again? Which high horse are you on that you get to dictate who gets care and who doesn't?
 
SBB2016 said:
Whatever, why did you go into medicine again? Which high horse are you on that you get to dictate who gets care and who doesn't?
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I never said someone should get care over someone else. Nor do I care to dictate who gets care or who doesn't. I'll leave that to the gatekeepers.

I just took your last statement and informed you that you were quite hypocritical from your initial stance of "everyone should receive medical care."

FWIW, they can give medical care to everyone and anyone, as long as they're needing surgery, I'm down with putting a tube down their throats and keeping them alive while having surgery. Doesn't faze me one bit. I'm glad there's folks who want to be PCPs and ER docs, God bless 'em, but that just wasn't for me.

just for kicks, I'll throw a little Dr. Cox in for you, as well.

[YOUTUBE]http://www.youtube.com/watch?v=imI8baMrfGo[/YOUTUBE]
 
Doctor4Life1769 said:
FWIW, they can give medical care to everyone and anyone, as long as they're needing surgery, I'm down with putting a tube down their throats and keeping them alive while having surgery.
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Most people, of course, will never require surgery or emergency medical care, and those who do quite frequently could've avoided it had they received decent primary care in the first place.
 
Blue Dog said:
Most people, of course, will never require surgery or emergency medical care, and those who do quite frequently could've avoided it had they received decent primary care in the first place.
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I agree 110%.

Most of the folks who get operated on are due to non-compliance. They have uncontrolled CAD, HTN, T2DM, end up with an MI and PVD. Lots of vasculopaths are having surgery. The old folks who break a bone due to osteoporosis.

The gov't is all smoke-screens and playing into what the "have-nots" want. But they're not doing them any favors, though.

Why is it that junk food is cheaper than healthy, better quality foods? Why is it that ciggs and alcohol aren't heavily taxed?

Education is controlled by the gov't... and we see how a colossal failure that has been compared to other 1st and 2nd world countries. Do you really think the gov't is going to properly solve the rising costs of healthcare? Hell no. These people living in this country are the top cause of high cost due to their non-compliance and crappy diet/lifestyle, and unfortunately doctors are the scapegoats.
 
Other governments can make it work, what makes ours so inept?
 
Doctor4Life1769 said:
I agree 110%.

Most of the folks who get operated on are due to non-compliance. They have uncontrolled CAD, HTN, T2DM, end up with an MI and PVD. Lots of vasculopaths are having surgery. The old folks who break a bone due to osteoporosis.

The gov't is all smoke-screens and playing into what the "have-nots" want. But they're not doing them any favors, though.

Why is it that junk food is cheaper than healthy, better quality foods? Why is it that ciggs and alcohol aren't heavily taxed?

Education is controlled by the gov't... and we see how a colossal failure that has been compared to other 1st and 2nd world countries. Do you really think the gov't is going to properly solve the rising costs of healthcare? Hell no. These people living in this country are the top cause of high cost due to their non-compliance and crappy diet/lifestyle, and unfortunately doctors are the scapegoats.
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Ummm cigarettes are heavily taxed...Phillip Morris cites that 56.6% of the price of cigarettes is from various state, local, and federal taxes. Obviously it depends on the state and local laws, but the point is that the taxes are a lot.

http://www.philipmorrisusa.com/en/c...ssues/Cigt_Excise_Tax/default.aspx?src=search

And more recently, on February 4, 2009, the Children's Health Insurance Program Reauthorization Act of 2009 was signed into law, which raised the federal tax rate for cigarettes on April 1, 2009 from $0.39 per pack to $1.01 per pack.

Alcohol is also taxed seperately: http://taxfoundation.org/article/st...garette-and-alcohol-tax-rates-state-2000-2010

So-called "fat taxes" are also being tried out in different countries, notably in Denmark in 2011: http://www.bbc.co.uk/news/world-europe-15137948

Also surely you saw the uproar over the soft drink tax in New York, which shows that to implement something similar in the US would be very difficult.

As far as the government trying to increase incentives for people to eat more nutritious foods, there is currently a pilot program under food stamps trying to do just that:

http://www.fns.usda.gov/snap/hip/default.htm

While you can see that the government actually DOES take proactive steps to address these concerns, there are also many things the government does which are not constructive.

Subsidies for corn have produced an excess and so that excess corn is funneled into creating lots and lots of processed food, which thanks to the subsidies, is also much cheaper than fresh produce. It's easy to blame the government, but you have to remember these policies are supported by heavy lobbying from the private sector, and then the American people vote in these politicians who enforce the policies.

Also I agree with you that the best solution is a good educational system, but with our politicians continuing to cut down on funding for public education, how is it supposed to get better?

The government CAN solve these problems, but new policies need the support of people who fight against PRIVATE interests.

Anyway that was a bit off-topic, but I think doctors can play a large role in correcting these problems through political advocacy for increasing access to health care as well as through supporting initiatives in healthy living and preventative care. Primary care physicians are at the forefront and I think that should also be highlighted as a plus for students trying to figure out which specialty they want. I like this poll done on SDN, and for students who want to make a difference, it's clear where they should be:

http://forums.studentdoctor.net/showthread.php?t=879015
 
SBB2016 said:
Other governments can make it work, what makes ours so inept?
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Exactly which governments currently "make it work"?

The loss of the private practice GP is arguably the greatest hit in our increasing health care delivery/costs. It has removed the financial incentive from the doc, while driving up costs, as well as destroying the relationship developed from actually knowing your patients. This reduces the physician's ability to actually make any kind of difference in the patients life choices leading to the need for prescribing lots of drugs and procedures, which along with insurance companies in general drive up costs.

HMOs and factory medicine is the death kneel of health care and I for one will do all I can to oppose it. Other countries that practice this way a) have poor care b) rely on the innovations of our country to make their care affordable.
 
Norway. They even have a king. France's system doesn't bring complaints from my friends who live there, actually the UK's system doesn't bring complaints from my friends who live there either, neither does Germany's. While Canada's systems gets complaints, the people still say they'd never trade it for what we have... oh, Costa Rica too... and they're 3rd world and they can still make it work...
 
Saying that "none of my friends are complaining" isn't a particularly useful statistic, particularly since your friends are likely young and healthy and rarely need to access the healthcare system in the first place.

A good read: "Universal Problems & Universal Healthcare: 6 Countries - 6 Systems"

It's ca. 2004, but still applicable today.

http://www.willamette.edu/centers/p...onsfuture/PDFvol5no2/countries_healthcare.pdf

See also: "International Profiles of Healthcare Systems, 2011" from the Commonwealth Fund.

http://www.commonwealthfund.org/~/m...Nov/1562_Squires_Intl_Profiles_2011_11_10.pdf
 
I wouldn't make an assumption that my friends are young and healthy. I have friends who span the range from 20-75, and their families. I can certainly say that our system is as far from perfect as it can get. Private insurance is a money-making scheme that allows someone else to make money as a middle man between you and I. That means you get less money, and I pay more for what I get, that's F'd up. Private health insurance was the worst thing to happen to medicine pretty much ever. We had lower costs (considering inflation) in the 60s before health insurance companies were created by the Nixon admin's brilliant idea. We would be better off getting rid of it, and the Reagan admin's unfunded mandate of EMTALA, than keeping private health insurance and doing nothing about rising costs. OR we have socialized medicine like most of the rest of the 1st world countries, all of which beat us in most health-related statistics like infant-mortality... BCBS pays less than 15% of what they are billed (at least according to the statements I receive)...
 
These sort of discussions really belong in Topics in Healthcare, unless they're specifically related to Family Medicine.
 
SBB2016 said:
I wouldn't make an assumption that my friends are young and healthy. I have friends who span the range from 20-75, and their families. I can certainly say that our system is as far from perfect as it can get. Private insurance is a money-making scheme that allows someone else to make money as a middle man between you and I. That means you get less money, and I pay more for what I get, that's F'd up. Private health insurance was the worst thing to happen to medicine pretty much ever. We had lower costs (considering inflation) in the 60s before health insurance companies were created by the Nixon admin's brilliant idea. We would be better off getting rid of it, and the Reagan admin's unfunded mandate of EMTALA, than keeping private health insurance and doing nothing about rising costs. OR we have socialized medicine like most of the rest of the 1st world countries, all of which beat us in most health-related statistics like infant-mortality... BCBS pays less than 15% of what they are billed (at least according to the statements I receive)...
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Actually agreed with a good chunk of what you said except EMTALA.
I have had too many patients with MIs and a few Ob/gyn patients where EMTALA was the only reason they got transferred to an appropriate facility. I think some of your thinking will change when you start rotations and residency.
 
Blue, how did we get on this conversation? Does it matter in a 7pg thread?


Makati,I am not saying EMTALA should go away, it just shouldn't be unfunded where the hospitals transfer the costs on to everyone else... It is morally wrong to send a person away with life threatening injuries because of money, although I know people (physicians even) who think it should happen. They think it would create a "seeeee, get your act together we're not going to 'give' away healthcare anymore".....
 
SBB2016 said:
I wouldn't make an assumption that my friends are young and healthy. I have friends who span the range from 20-75, and their families. I can certainly say that our system is as far from perfect as it can get. Private insurance is a money-making scheme that allows someone else to make money as a middle man between you and I. That means you get less money, and I pay more for what I get, that's F'd up. Private health insurance was the worst thing to happen to medicine pretty much ever. We had lower costs (considering inflation) in the 60s before health insurance companies were created by the Nixon admin's brilliant idea. We would be better off getting rid of it, and the Reagan admin's unfunded mandate of EMTALA, than keeping private health insurance and doing nothing about rising costs. OR we have socialized medicine like most of the rest of the 1st world countries, all of which beat us in most health-related statistics like infant-mortality... BCBS pays less than 15% of what they are billed (at least according to the statements I receive)...
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Probably the worst statistic to cite when comparing US healthcare with other countries (so much variance on what other countries use as "infant mortality"). I think healthcare in the US, is the best in the world..if you can afford it. If you can't (i.e. uninsured/underinsured then you're up sh$t creek with no paddle)

Also, I wouldn't be lecturing Blue, especially when he gives you peer reviewed studies on healthcare comparisons between the US and other countries systems.
 
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The questions should be "Why Encourage Medical Students To Choose Primary Care?". It's several years since I visited these forums and the take over of primary care by midlevels continues on its unstoppable path. Nursing organizations continue to push for, and get, more practice rights while primary care docs get squeezed more and more on income.

Why not ensure medical students know the truth and encourage them to train in an area where they won't be threatened by NPs. Make sure they know that after 4 years of undergrad, 4 years of med school, and 3 years of residency that they will be competing in the job market with someone with a 2 year AA followed by a 2 year online BSN and a 2 year online NP.
 
George85 said:
It's several years since I visited these forums
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We didn't miss you a bit.

Why not ensure medical students know the truth and encourage them to train in an area where they won't be threatened by NPs. Make sure they know that after 4 years of undergrad, 4 years of med school, and 3 years of residency that they will be competing in the job market with someone with a 2 year AA followed by a 2 year online BSN and a 2 year online NP.
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Why not...? Well, for starters, because (unlike you) I actually know what I'm talking about. :rolleyes:
 
SBB2016 said:
Other governments can make it work, what makes ours so inept?
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Well Blue Dog you've really hurt my feelings. And I'm glad you're so sure of your own knowledge - me, I just accept that there's not much I know - in fact, the older I get the less I seem to know. But I suspect that I know just a little bit about the midlevel assault on family medicine. My wife's an ICU nurse and completed her BSN online. Most of the nurses she works with either go onto CRNA or NP - and most of those that do NP do so online and part-time - take a look at:
http://www.troy.edu/catalogs/1112grad/6G_hhs.html#masterofscienceinnursing.

This is the curriculum for Family Nurse Practitioner. The course is online except for Primary Care Preceptorship 1 and 2 (total 6 credit hours) and internship of 5 hours. Total of 11 credit hours where another NP teaches the student how to practice medicine and not nursing - what a smart idea.

Now, consider the ER that I work in - FP docs work in the fast track section but not the main ER - take a guess at who does work the main ER - NPs and PAs. So, I have midlevels that technically work under me managing chest pain, abdo pain, etc, but the FP doctors are not able to get ER privileges because they would be working independently. Now, tell me that's not messed up.

I realize that certain parts of the country are better for FM practice but overall it's a field that's in decline and under pressure from all sides. It really is about time that we encouraged med student to avoid family medicine until this country sorts out the health care system. At least with IM you can go onto a fellowship.
 
George, showing up here every couple of years to spout the same nonsense about "midlevels taking over" is nothing more than trolling, and you know it. If you had anything more than that to contribute, you'd be a regular poster here and not just somebody who stops in when they want to stir the pot.

I'm not even going to waste my time arguing with you, because in your absence, there have been countless threads about this same subject. Maybe you should read them instead of trying to steer this thread off-topic.
 
As I'm not very forum aware I assume trolling means trying to create a reaction - I thought that was flaming - guess I'll have to google all that.

Anyway, the reason I "spout the same nonsense" is because the midlevel issue is something that really pisses me off. Sure, primary care has many other issues but I believe that this potentially the most damaging one. And my posts from several years ago still stand even though at the time they had many people holding their breath and stamping their feet,

And the reason I post so infrequently is that I simply don't look at these forums very often - couple of times a year - even then I don't usually post - but when I see a thread like yours then I can't help myself. That's because I was one of those people encouraged to sign up for FM residency - it wasn't a complete waste of my time as all post grad experience is valuable and much of what I do now in EM is essentially primary care - but there were certainly people who I suspect were economical with the truth when I was being encouraged to sign up for FM - I was on the fence regarding ob/gyn and was under the impression that FM was able to more ob than it does - the further north you go the better it is but here in Florida you won't find any FM docs doing deliveries. It's not that med students shouldn't go into FM - it's just that they should be given a truthful and clear picture so that they can make a fully informed decision.

And if you don't think FM is in decline just take a look at the title of your thread.
 
George, this thread started two years ago. I hadn't even looked at the OP until earlier today (and updated the link to the article it referenced, as it had broken).

The specialty is not in "decline." There is more demand for good family physicians than ever before. You seem to think that midlevels want our jobs so badly, but have you bothered asking why?

On a related note, the "pay specialists less" approach referenced in the OP is now being advocated by CMS.

http://forums.studentdoctor.net/showthread.php?t=929989
 
Hmmm... if the speciality is in decline I am sure getting a lot of really nice job offers... in really nice places... with really nice benefits...
 
So, to rekindle the spirit of the thread: I just came off a 4-wk rural FM rotation. I had a blast. Now I am on 4 wk inpatient geriatrics-IM consult and my only entertainment is a particularly wacky bipolar dude in renal failure. I want to go back to FM...it was nice to remember how much I liked it.
I spent the first half (6 yr) of my PA career in FM. Left it because I was bored, went to EM. Not bored there but not happy either. Felt like a little bit of my kindness drained away with each ED shift. FM brought it back...and a year in the classroom not treating patients.
I have had plenty of folks tell me I would be an idiot to go into FM as a former PA who should know better...but I think I was bored because of my limited scope of practice and that I outgrew the role. I don't think I could do JUST outpt FM though...I would certainly be bored then. If some community-based FM residency program put me on staff and I got to teach, take care of patients and influence public health policy while making a wage that justified going back to medical school at 37, I would be very happy.
BlueDog, you are fond of saying that if a family physician thinks s/he can be replaced by a PA or NP, maybe she should be. IMO there is plenty of work for all of us and the roles are different. Being a PA, I know what PAs know and what they do and don't learn. I have a pretty good handle on what NPs do and don't know as well.
And for the record, I have been one of those PAs who worked up the complicated ED cases and presented them to my attending for blessing whilst the family doc staffs fast track...always seemed nuts to me too but it was a revenue issue for the practice. I have also done my fair share of fast track and urgent care solo...in most cases it depends on the EM practice group and the hospital culture.
 
primadonna22274 - of course rural FM can be fun - never boring that's for sure - but when it's your career and you're on call 24x7 then it starts to get old and you get worn out. And even more annoying when surgery simply says admit to medicine or primary for appendicitis on someone with no additional medical factors. And yes, the roles are different - but for how long? All the midlevel provider associations are always pushing for more practice rights and they will gradually get them because society needs primary care. So, why would the med student with outrageous debt go into a role where they are valued the same as an NP/PA ? Your case is different - you appear to fully understand the issues facing FM and so you're able to make an informed decision - that's great because as a job FM can still be fun - image being a hand surgeon - all that training to just work on hands all day - would drive me crazy - but at least the surgeons are not being threatened by midlevels - and by threat I don't mean that there won't be jobs, I mean that income will reduce. So, there comes a point where it simply isn't worth it for med students to go into primary care - and that's where we are headed, and there won't be any turining back. What sort of health care system spends most of it's budget on tertiary care while spending the least on primary care? There needs to be some sort of revolt where primary care simply stops making referals and stops making consults - at least to a bare essential minimum - trouble is that primary care often relies on volume.
 
RPW - yes the speciality is in decline - that doesn't mean that there will be less jobs - there will be more jobs in primary care - but the differential between primary care and everyone else will become so large that primary care will cease to be staffed by doctors - or the doctors will be the senior members in larger groups of mainly midlevels.

>>I am sure getting a lot of really nice job offers... in really nice places... with really nice benefits...

I was going to into perspective for you but you probably would not believe the figures - let us just say that no nights, no on-call, and least 18 days off a month = I have a life. Why would I want to get paid substantially less and get dumped on by a broken health care system?
 
There is no evidence that having midlevels involved in primary care results in decreased reimbursement. Healthcare is not a free market.

Reimbursement is based on CPT codes. The trend is towards increasing reimbursement for primary care CPT codes at the expense of specialty codes to maintain budget neutrality. Payment reform and delivery system redesign (e.g., PCMH etc.) will also likely increase primary care reimbursement and provide incentives to improve the quality of care overall. This is a win-win for patients, employers, and primary care providers alike.
 
Blue Dog, what do you think of Texas Tech's F-MAT program for recruiting future family physicians?
 
Chaka27 said:
Blue Dog, what do you think of Texas Tech's F-MAT program for recruiting future family physicians?
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I don't have anything against it per se, but I wouldn't have wanted to be functioning as a full-fledged intern in my fourth year of med school. That extra year makes a difference, IMO.
 
George85 said:
RPW - yes the speciality is in decline - that doesn't mean that there will be less jobs - there will be more jobs in primary care - but the differential between primary care and everyone else will become so large that primary care will cease to be staffed by doctors - or the doctors will be the senior members in larger groups of mainly midlevels.

I was going to into perspective for you but you probably would not believe the figures - let us just say that no nights, no on-call, and least 18 days off a month = I have a life. Why would I want to get paid substantially less and get dumped on by a broken health care system?
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Yeah because the offers I'm seeing in urban areas for 40hr/wk, no nights, no weekends, no inpt, no ob, and no call for 200k + are obviously peasants wages and just a terrible lifestyle that I wouldn't wish on my worst enemy...

Hell, if I wanna wake up and drive half an hour in the morning I start seeing numbers for hospitalist gigs that start with 3's have no call and ya get 14 days a month off...

If only some specialist with a much longer training pathway and a less flexible scope of practice had warned me in time then maybe I wouldn't be cursed with being 30 yrs old, having a low loan burden, great salary, and excellent lifestyle...


Whoa is me... What will I ever do with myself???
 
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