I'm going to represent a minority view here, and probably will catch a lot of heat for it, but here goes...
Most (though not all) people who chose to go to medical school with primary care in mind do so because they have some notion of wanting to make a difference in their patients' lives. They (myself included) want to be able to meaningfully affect behavioral change, stop or slow disease processes, fix injuries, and feel good about the fact that they are improving the quality of life of their patients by promoting and maintaining good health. Many of us envision also having a meaningful physician-patient relationship, in which we actually know our clients.
In today's world of managed care, the "traditional" doctor-patient relationship is under attack. Physicians are pressured to deliver care in ways that go beyond efficiency to downright rushed interactions. The bulk of the average doctor's time is no longer comprised of face-to-face time with the patient. It is a hectic schedule of managing paperwork and reimbursement, charting and billing, and guarding obsessively to prevent malpractice suits (a real reality). What is lost is the humanistic, caring part of health care.
That role has been increasingly taken up by other medical staff. Nurses, clinic assistants, PAs, NPs, and other advanced nursing staff are becoming the major providers of healthcare (excluding the most technical aspects, such as advanced surgery). This is inevitable: the average doctor could not possibly take on the responsibility of all of these tasks and still practice in a financially viable manner. The doctor is becoming more of an overseer of health care, while the actual providers--the people who take the histories, do the vital signs, perform the exams, do the minor procedures, give the information, prescribe the medications, have the real relationships with the patients, are other staff. I'm not saying that this is the ideal model, but it is generally a reality. Think about when you go to the doctor. You probably see about three other people before you even get to a doctor--if you even do see a doctor--and then it's probably for less than 5 minutes.
The major question, then, is is this a bad thing? I'm going to be a devil's advocate and suggest that maybe it's not. It's interesting to me that in response to this trend, so many of you take a clearly negative position towards other medical professionals. While you may feel that your job or salary is being threatened, I assure you that there is still a very real need for doctors, and I don't see it as likely that doctors will be out of their jobs anytime soon. Furthermore, it is impossible to deny that there is a real shortage of nurses and other similarly educated medical professional staff. Why wouldn't we as physicians or future physicians want to encourage the benefits that will hopefully draw more people into these careers? After all, we need them if we are to practice (primary) care in the current dominant model. It is true that physicians face tremendous financial burdens and years of hardship during and immediately after their very long educations. But we must be careful not to loose sight of our mission. We are, after all, here to serve our patients, not ourselves. And if re-structuring professional heirarchies will result in better, more compassionate, more accessible, and less expensive care for our patients, shouldn't we be open to that idea for consideration? Isn't it possible that one of the factors that drives up health care costs is the investment that occurs in physician education and the subsequent need for docs to garner big salaries to make up for massive debt? What if it other medical staff can take on more tasks that a physician used to do? What if it cost less to educate medical staff? Would medical costs decrease?
Finally-and I apologize for rambling on and on- I just want to implore my future colleagues to maintain the highest levels of professional respect to nurses, NPs, PAs, DNPs, etc. They provide a valuable service, and it is unfortunate that I have often witnessed rather self-important egos treating them badly or excessively paternalistically. Many are stellar providers, more responsive to their patients' needs, better practiced thorough experience, and as dedicated as any MD. Having the medical support staff fully on your side is always beneficial. After all, it may one day be a vigilant nurse who catches the mistake that could have ruined your career.
