If specialists and PCPs are over-worked, why not drastically increase their #s?

[zut212]

I have always heard - and so have you - that there are so many specialists in this country. We have ~70% of our physicians are specialists, and the balance are PCPs.

PCPs are over-worked. So because we have relatively too many specialists, do they have much less work?

Also, are there *relatively* or *absolutely* too many specialists? The former means we have too many specialists relative to PCPs, and the latter means we have too many specialists in general.

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[SemperJeff]

And how do you propose that we drastically increase the #s of PCPs?

 

[zut212]

And how do you propose that we drastically increase the #s of PCPs?

Hmmm...I have no clue on what we can do to increase PCPs. What do you think that we should do?

 

[FalcorMed]

Troll

 

[WellWornLad]

The same dynamic that is ramping up need for services (i.e., the baby boomer generation turning 60+) is going to lead to a dramatic reduction in physicians as about 30% of current doctors will be retiring over the next 10 years. So everyone is pretty busy these days.

In any case, folks are trying to increase the number of PCPs - by increasing the number of med students without increasing the number of residency slots to force med students to take unfilled family medicine training slots.

Good luck, OP - I certainly am glad that I'll be through to residency before it gets crazy competitive.

 

[cpants]

The same dynamic that is ramping up need for services (i.e., the baby boomer generation turning 60+) is going to lead to a dramatic reduction in physicians as about 30% of current doctors will be retiring over the next 10 years. So everyone is pretty busy these days.

In any case, folks are trying to increase the number of PCPs - by increasing the number of med students without increasing the number of residency slots to force med students to take unfilled family medicine training slots.

Good luck, OP - I certainly am glad that I'll be through to residency before it gets crazy competitive.

True. There is a shortage of doctors in almost every specialty. The PCP shortage is just relatively more desparate. No doctors are struggling to fill their days.

 

[zut212]

The same dynamic that is ramping up need for services (i.e., the baby boomer generation turning 60+) is going to lead to a dramatic reduction in physicians as about 30% of current doctors will be retiring over the next 10 years. So everyone is pretty busy these days.

In any case, folks are trying to increase the number of PCPs - by increasing the number of med students without increasing the number of residency slots to force med students to take unfilled family medicine training slots.

Good luck, OP - I certainly am glad that I'll be through to residency before it gets crazy competitive.

Thank you WellWorn.

This is what I've learned from you: I originally thought/assumed that specialists had less work to do than PCPs, but as it turns out, they both have a lot of work to do. What can be done regarding this is that there is an increased number of MDs WITHOUT a cocomitant increase in residency spots. I don't understand how this would channel more MDs into PCP positions, but I think that we're on to something. Great answer once again.

 

[zut212]

True. There is a shortage of doctors in almost every specialty. The PCP shortage is just relatively more desparate. No doctors are struggling to fill their days.

Cpants,

It seems that there is a shortage of MDs in almost every specialty. I agree with you.

What do YOU propose to increase the number of MDs? It seems that every proposal that I have made is met with stiff resentment, passive aggressiveness, and verbal abuse.

Once again: What do *YOU* propose to increase the number of MDs?

 

[cpants]

Cpants,

It seems that there is a shortage of MDs in almost every specialty. I agree with you.

What do YOU propose to increase the number of MDs? It seems that every proposal that I have made is met with stiff resentment, passive aggressiveness, and verbal abuse.

Once again: What do *YOU* propose to increase the number of MDs?

Basically we need to increase the number of residency spots. The determinate of how many new docs we get each year is the number of residency spots, not the number of medical school spots. The new residency spots would largely be staffed by FMG's until the number of medical students could be increased to fill them.

There is no shortage of people who want to be physicians practicing in this country. It's estimated that half of all qualified applicants to medical school are rejected each year. We need to step up our training efforts to fill the gap. Resistance to this has led to a surge in mid-levels to fill the gap, which helps no one.

 

[CarlATHF]

I'm not writing your Healthcare Policy 101 essay. You're a big boy, come up with your own arguments.

 

[OveractiveBrain]

Troll

So others realize what he means, zut goes around posting in different forums some "stimulating questions." I hope that this is an attempt to get conversation started amongst the next wave of physicians.

I'm not writing your Healthcare Policy 101 essay. You're a big boy, come up with your own arguments.

I fear, however, that it is more likely as cweave said, that zut is just pumping the knowledgeable for their info, rather than stimulate what needs to be said.

 

[jj6vcb]

The same dynamic that is ramping up need for services (i.e., the baby boomer generation turning 60+) is going to lead to a dramatic reduction in physicians as about 30% of current doctors will be retiring over the next 10 years. So everyone is pretty busy these days.

In any case, folks are trying to increase the number of PCPs - by increasing the number of med students without increasing the number of residency slots to force med students to take unfilled family medicine training slots.

Good luck, OP - I certainly am glad that I'll be through to residency before it gets crazy competitive.

Shouldn't this be about the average? I mean unless there are doctors out there practicing full time for much longer than 30 years, you'd think that every 10 years there would be 30% turnover.

And there have to be more med school grads per year now than there were then

 

[DrBowtie]

Cpants,

It seems that there is a shortage of MDs in almost every specialty. I agree with you.

What do YOU propose to increase the number of MDs? It seems that every proposal that I have made is met with stiff resentment, passive aggressiveness, and verbal abuse.

Once again: What do *YOU* propose to increase the number of MDs?

I don't want to do anything. Keep the supply low and protect our job prospects. Lots of fields have boom/bust cycles where there is saturation, residency programs close, then reopen.

Your real focus should be convincing top notch students to do primary care.

 

[zut212]

Your real focus should be convincing top notch students to do primary care.

How would you convince top notch student to do primary care?

 

[Antibodies]

I am not exactly sure why I hear "we need more primary care residency spots." From my understanding, there are tons of primary care spots that go unfilled each year (correct if I am wrong please). So we need people to fill the spots, not more spots. The way to do this is to make primary care more attractive, currently it is not a very appealing field.

 

[Antibodies]

How would you convince top notch student to do primary care?

Easy, just pay them more. Money is the biggest incentive you can provide. Pay off their loans, increase reimbursement.

Also, OP, why are you back why these "stimulating questions." Didn't they ask you to take this to some other board?

 

[cpants]

I don't want to do anything. Keep the supply low and protect our job prospects. Lots of fields have boom/bust cycles where there is saturation, residency programs close, then reopen.

Your real focus should be convincing top notch students to do primary care.

It's a selfish way to look at things. I am not one of those people who thinks doctors should not think about money, but I also don't think we should try to protect our job security at the expense of public health. Our supply of doctors has not increased to match the increase in our population. Artificial suppression of supply has not only not protected our income, it has led to a widespread increase in midlevel use which demeans our education. It has led to widespread rationing of care. Sure the job security is there, but it is not worth it.

 

[WellWornLad]

Easy, just pay them more. Money is the biggest incentive you can provide. Pay off their loans, increase reimbursement.

That would go a long way, I agree. However, I just feel that primary care is a tough sell for many other reasons. I wouldn't do it even if the compensation was derm-level. I don't really want to go through 11 years of training to reassure someone that they don't need antibiotics for their sniffles, or that they really should lose 20 lbs, or lecture someone for the umpteenth time to take their meds, or spending half my time figuring out what hoops I have to jump through on my note and claim form to actually get paid by insurance companies.

It just takes a special kind of person to do primary care. And these days people tend to treat their doctor like any other service provider. They are more demanding and skeptical of any treatment that requires a modicum of effort on their part. Frankly, I'm all for using midlevels as PCP if it'll put a buffer between people who just need reassurance or another lecture on weight loss and those who actually have medical problems that they can't solve on their own.

 

[MCAT guy]

The solution is simple (and may be beginning). Rapidly increase the amount of medical graduates while inhibiting any increase in residency positions. Residencies become more competitive and PCPs increase.

Another option is to let nurses and PAs take over the PCP role.

 

[Cruzinman]

Specialists are "overworked" because they do too many procedures, driving up the cost of medical care, IMHO.

 

[IHeartNerds]

Easy, just pay them more. Money is the biggest incentive you can provide. Pay off their loans, increase reimbursement.

Completely untrue. People don't go into family medicine because the money sucks (although it does), people don't go into FM because they don't find it interesting.

Making FM more "competitive" by increasing US grads without increasing residency spots will squeeze out FMGs and increase US grads going into primary care. This is true. It also means more people in primary care would be bitter and unproductive because they wanted to go into something else but didn't achieve well enough in med school. I would expect the number of "sports medicine" family docs to increase, as well as the number of boutique / no-insurance-accepted practices. I doubt that would satisfy the need for primary care doctors in North Dakota.

US grads will continue to not want to go into primary care. Why? Because most medical schools select people for admission who are not personality-compatible with FM/primary care.

 

[zut212]

The solution is simple (and may be beginning). Rapidly increase the amount of medical graduates while inhibiting any increase in residency positions. Residencies become more competitive and PCPs increase.

Another option is to let nurses and PAs take over the PCP role.

Now that's a very creative solution for a very big problem. I agree with you. This is one possibility that could be done. Great thinking and courage to post your solution (now put on your flame-shields from many passive-aggressive types here).

 

[zut212]

Specialists are "overworked" because they do too many procedures, driving up the cost of medical care, IMHO.

The cost of this defensive medicine is only $46B for a $2.4T sector. This is very miniscule, but I appreciate your answer.

 

[zut212]

Completely untrue. People don't go into family medicine because the money sucks (although it does), people don't go into FM because they don't find it interesting.

Making FM more "competitive" by increasing US grads without increasing residency spots will squeeze out FMGs and increase US grads going into primary care. This is true. It also means more people in primary care would be bitter and unproductive because they wanted to go into something else but didn't achieve well enough in med school. I would expect the number of "sports medicine" family docs to increase, as well as the number of boutique / no-insurance-accepted practices. I doubt that would satisfy the need for primary care doctors in North Dakota.

US grads will continue to not want to go into primary care. Why? Because most medical schools select people for admission who are not personality-compatible with FM/primary care.

My opinion is that we have an acute shortage of physicians in general. The USA only has about 2.5 MDs per 1000 citizens in the USA, and over 25% are FMGs, typically from China and India - countries that need their physicians more than we do.

We need more residency spots. There are only 100,000 right now, and about 18,000 MDs graduate each year. So it looks like we have enough residency spots but not enough MD-student spots.

I have my flame shields on from all you haters of "increased MD school capacity" ideology.

 

[Dr McSexy]

How would you convince top notch student to do primary care?

Why do they need to be "top notch"?

As stated, they are plenty of FMGs who are unmatched. Increasing the residency slots designates specialties (i.e. family practice) would allow the unmatched FGMs to fill those slots until the supply of US medical students increases to overtake those spots.

Other alternatives are to increase the number MD programs that pay for your school tuition if you choose to enter a PCP field and many of these include extra stipulations such as serving a rural community for X amount of years.

 

[Dr McSexy]

We need more residency spots. There are only 100,000 right now, and about 18,000 MDs graduate each year. So it looks like we have enough residency spots but not enough MD-student spots.

Don't know where exactly you getting the numbers.

But annually there are about ~25,000 spots available. 2010 match had ~30,000 applicants.

 

[zut212]

Don't know where exactly you getting the numbers.

But annually there are about ~25,000 spots available. 2010 match had ~30,000 applicants.

Given that there are only 18,000 docs that graduate every year, 25,000 spots available is not bad.

I'm not sure if this 18,000 includes DOs, or FMGs.

I'm not sure how we get 30,000 applicants a year, frankly given the 18,000 grads/year.

 

[musafirah]

loan repayments for PCPs in rural/underserved areas is a good start i'd say. we should extend that..

 

[Dr McSexy]

I'm not sure how we get 30,000 applicants a year, frankly given the 18,000 grads/year.

 Seniors of U.S. Allopathic Medical Schools (U.S. Senior): A fourth-year medical
student in an LCME-accredited U.S. allopathic school of medicine. A student with
a graduation date after July 1 in the year before the Match is considered a U.S.
senior. U.S. seniors are sponsored by their medical schools.
 Previous Graduates of U.S. Allopathic Medical Schools (U.S. Grad): A graduate
with a graduation date before July 1 in the year before the Match is considered a
previous U.S. graduate and is not sponsored by the medical school.
 Students/Graduates of Canadian Medical Schools (Canadian)
 Students/Graduates of Osteopathic Medical Schools (Osteo.)
 Students/Graduates of Fifth Pathway Programs (5th Pathway)
 U.S. Citizen Students/Graduates of International Medical Schools (U.S. IMG)
 Non-U.S. Citizen Students/Graduates of International Medical Schools (Non-U.S.
IMG

16,000 U.S. Seniors applied. The other 14,000 was combined the other 6 groups on the list.

ETA:
IMGs (non-US) - ~7,000
IMGs (US) - ~4,000
D.O. - ~2,000
Previous Grads - ~1,000

 

[DrBowtie]

Completely untrue. People don't go into family medicine because the money sucks (although it does), people don't go into FM because they don't find it interesting.

Making FM more "competitive" by increasing US grads without increasing residency spots will squeeze out FMGs and increase US grads going into primary care. This is true. It also means more people in primary care would be bitter and unproductive because they wanted to go into something else but didn't achieve well enough in med school. I would expect the number of "sports medicine" family docs to increase, as well as the number of boutique / no-insurance-accepted practices. I doubt that would satisfy the need for primary care doctors in North Dakota.

US grads will continue to not want to go into primary care. Why? Because most medical schools select people for admission who are not personality-compatible with FM/primary care.

People don't even give a fair shake because they make 100-150k. If said numbers were 300-400k, you would certainly see more people choosing it. You often see people deciding FM vs. IM vs. Med/Peds but choose against FM because of a higher earning potential.

Surely the reason why Derm is super competitive is that everyone finds the skin absolutely fascinating.

 

[gravitywave]

The solution is simple (and may be beginning). Rapidly increase the amount of medical graduates while inhibiting any increase in residency positions. Residencies become more competitive and PCPs increase.

Another option is to let nurses and PAs take over the PCP role.

no, this won't work. it's not like there are thousands of FM residency slots that go vacant every year. the total number of unfilled residency slots last year was ~1,000, and 40% of those were prelim surgery years, which are considered undesirable for reasons unconnected to the PCP crisis. All your plan would do is decrease the number of IMG/DOs that match.

NP/PA is an option - but not a good one.

Completely untrue. People don't go into family medicine because the money sucks (although it does), people don't go into FM because they don't find it interesting.

if you were to double the compensation for FM, many more medical students would find it "interesting," trust me. Students at most US medical schools don't give FM the time of day because 1) it's not very lucrative, 2) it's not considered very prestigious. I leave it to you to determine to what degree (1) influences (2).

An example from history: forty years ago, you couldn't give away derm residencies in this country. It was considered a good place to put people who were too stupid/lazy for IM, a place where they couldn't do any harm. Then, dermatology discovered procedures and how to turn them into a business. Now it's arguably the most competitive residency out there.

US grads will continue to not want to go into primary care. Why? Because most medical schools select people for admission who are not personality-compatible with FM/primary care.

this i agree with 100%, but i still believe you could redirect their "passions" with more money.

The cost of this defensive medicine is only $46B for a $2.4T sector. This is very miniscule, but I appreciate your answer.

you misunderstood Cruzin's post: he was commenting on how procedure-driven the current Medicare reimbursement model is. Specialists make more money for doing more procedures, so there is a natural inclination for specialists to make their practices more procedure-driven as well. Electrophysiologists make lots more money than your plain-jane cardiologists because of the additional procedures the fellowship trains them for.

In contrast, PCP practices involve fewer procedures, and this is a major reason why they make less money.

Given that there are only 18,000 docs that graduate every year, 25,000 spots available is not bad.

I'm not sure if this 18,000 includes DOs, or FMGs.

I'm not sure how we get 30,000 applicants a year, frankly given the 18,000 grads/year.

the 18,000 are US MD 4th years. the other 12k are everyone else: IMG/DO/Canadian/non-4th yr US MDs.

so where does this leave us? We need more doctors, and more PCPs in particular. The bottleneck is in the number of residency slots, which are paid for by Medicare and the number is set by Federal law. That number hasn't increased in over ten years, supposedly because of the expense. In that time, the population has increased 12% and a large number of aging doctors are about to retire at the same time as the rest of their demographic cohort - and they will all want their Medicare.

The fanfare surrounding the AMA's increase in the number of seats at MD schools is cynical at best unless we can increase the number of residency slots as well. We also need a new reimbursement model that more accurately reflects the time and expertise it takes for PCPs to do their jobs well.

edit: lol the two peeps above me made the same points in the time it took me to bang all that out. oh well.

 

[MCAT guy]

no, this won't work. it's not like there are thousands of FM residency slots that go vacant every year. the total number of unfilled residency slots last year was ~1,000, and 40% of those were prelim surgery years, which are considered undesirable for reasons unconnected to the PCP crisis. All your plan would do is decrease the number of IMG/DOs that match.

NP/PA is an option - but not a good one.

I don't see your point. If I doubled the # of medical graduates while holding the residency spots constant then we have more PCPs.

I like the NP/PA option anyhow. The primary care role doesn't need that much training. Refer or offer simple treatments.

 

[zut212]

Hello there GravityWave,

You are brilliant and I appreciate your answer. I even found myself agreeing with a lot of your opinions (about how you agree with "most medical schools select people for admission who are not personality-compatible with FM/primary care."). Well done.

 

[Charles_Carmichael]

i still believe you could redirect their "passions" with more money.

Citation please (unless I'm misunderstanding what you're saying).

The primary care role doesn't need that much training. Refer or offer simple treatments.

IMO, you're completely wrong. Primary care is one of the toughest fields to go into. The breadth of knowledge you need to know as a PCP is just ridiculous! People seem to think that primary care is easy because it's not as competitive. That is not true. Competitiveness =/= difficulty. And I say this fully as a person who's not interested in primary care and is actually interested in a very competitive field.

As an attending wisely told me, mediocre primary care is easy to do. It's being a good PCP that's incredibly difficult!

To premeds (in general, since I'm still a premed): Don't consider a specialty to be "easy" just because it's not as competitive as other specialties.

 

[MCAT guy]

Citation please (unless I'm misunderstanding what you're saying).



IMO, you're completely wrong. Primary care is one of the toughest fields to go into. The breadth of knowledge you need to know as a PCP is just ridiculous!

Ok. Just curious, I will list some specialties. Tell me which specialties require less knowledge than primary care. I.e. which physicians operate off a smaller knowledge base than PCPs?

• Dermatology
• Plastic surgery
• Urology
• Ophthalmology
• Neurological surgery
• Orthopedic surgery
• Otolaryngology
• Radiation oncology
• Diagnostic radiology

Just name the specific specialties.

As an attending wisely told me, mediocre primary care is easy to do. It's being a good PCP that's incredibly difficult!

I agree here, but I also believe PAs and NP can learn the PCP role adequately.

 

[Charles_Carmichael]

Ok. Just curious, I will list some specialties. Tell me which specialties require less knowledge than primary care. I.e. which physicians operate off a smaller knowledge base than PCPs?

• Dermatology
• Plastic surgery
• Urology
• Ophthalmology
• Neurological surgery
• Orthopedic surgery
• Otolaryngology
• Radiation oncology
• Diagnostic radiology

Just name the specific specialties.

Better yet, why don't you tell me? Since you seem like such an expert on the topic...

I honestly don't think you can argue that any specialty requires a broader knowledge base than primary care does...Pretty much every specialty you listed is restricted to a certain set of pathologies. Not so with primary care. These physicians have to know everything about everything.

Like I said previously, I'm not interested in primary care. I'm heavily involved in radiation oncology research. And I would be more than happy to admit, based on my clinical experience thus far, that the knowledge base that PCPs require is faaaaaaaaar more extensive than that of specialists. Specialists have the minutiae down...but that's different than what I've been saying so far.

 

[MCAT guy]

I tend to agree with Gravity though on the idea that $ is a driver.

If a person owes 200k in debt, there is no way they will go into a difficult field and get paid little. I still don't believe the amount of knowledge that a PCP has to acquire is anywhere near that of some of the most knowledge intensive specialties.

 

[Charles_Carmichael]

I agree here, but I also believe PAs and NP can learn the PCP role adequately.

I vehemently disagree. Someone with less than 10% of the training that a PCP gets is nowhere close to being as competent as a PCP. Maybe with some common diseases, but that's it. You know who else is awesome at taking care of this common stuff? My mom. And she hasn't had an iota of medical training. Maybe she should be practicing independently...

 

[MCAT guy]

Better yet, why don't you tell me? Since you seem like such an expert on the topic...

I honestly don't think you can argue that any specialty requires a broader knowledge base than primary care does...Pretty much every specialty you listed is restricted to a certain set of pathologies. Not so with primary care. These physicians have to know a little bit about everything.

fixed.

They need to know very little about the treatment of any of these diseases. This is why they have to refer patients.

Like I said previously, I'm not interested in primary care. I'm heavily involved in radiation oncology research. And I would be more than happy to admit, based on my clinical experience thus far, that the knowledge base that PCPs require is faaaaaaaaar more extensive than that of specialists. Specialists have the minutiae down...but that's different than what I've been saying so far.

When people mention we have some of the best doctors in the world in America, it is because of their specialized knowledge in a narrow field.

I respect your opinion. But we can agree to disagree.

 

[zut212]

Citation please (unless I'm misunderstanding what you're saying).



IMO, you're completely wrong. Primary care is one of the toughest fields to go into. The breadth of knowledge you need to know as a PCP is just ridiculous! People seem to think that primary care is easy because it's not as competitive. That is not true. Competitiveness =/= difficulty. And I say this fully as a person who's not interested in primary care and is actually interested in a very competitive field.

Kaushik,

I suspect that you're trying to mislead the public here. How do you figure that PCP is *more* difficult? It has its own challenges, but it's less challenging/rigorous than general surgery. This is common sense for most of us here.

As an attending wisely told me, mediocre primary care is easy to do. It's being a good PCP that's incredibly difficult!

The same can be said for the guitar, driving a car, cooking, mixing drinks, or even surgery.

To premeds (in general, since I'm still a premed): Don't consider a specialty to be "easy" just because it's not as competitive as other specialties.

[/QUOTE]

There *maybe* some specialties that are easier *and* competitive to get into or easier specialties that are not competitive.

 

[Charles_Carmichael]

fixed.

They need to know very little about the treatment of any of these diseases. This is why they have to refer patients.

When people mention we have some of the best doctors in the world in America, it is because of their specialized knowledge in a narrow field.

I respect your opinion. But we can agree to disagree.

Thanks. And I fully respect your stance on this issue as well.

I just personally believe that primary care physicians require the broadest amount of training of any medical field. IMO, the PCPs you know that refer out everything are bad PCPs. A PCP is supposed to be able to handle pretty much everything and refer out in the few instances that they don't have a handle on what's going on. That's the benefit of PCPs: they can handle 99% of the stuff that walks through their doors by themselves. And this definitely does occur at a lot of primary care practices. I would contend that the PCPs referring out a lot are in the minority; however, this is based on anecdotal evidence rather than published literature, so I can obviously be wrong.

I just don't get this underappreciation that present-day society has regarding PCPs.

 

[deleted191570]

Ok. Just curious, I will list some specialties. Tell me which specialties require less knowledge than primary care. I.e. which physicians operate off a smaller knowledge base than PCPs?

• Dermatology
• Plastic surgery
• Urology
• Ophthalmology
• Neurological surgery
• Orthopedic surgery
• Otolaryngology
• Radiation oncology
• Diagnostic radiology

Just name the specific specialties.

Um, all of the above?

"which physicians operate off a smaller knowledge base than PCPs?"

I could be wrong, but I'm pretty sure almost no one in any of those fields would even feel entirely comfortable doing a consult for asthma, diabetes, or hypertension.

 

[MCAT guy]

I vehemently disagree. Someone with less than 10% of the training that a PCP gets is nowhere close to being as competent as a PCP. Maybe with some common diseases, but that's it. You know who else is awesome at taking care of this common stuff? My mom. And she hasn't had an iota of medical training. Maybe she should be practicing independently...

Btw, "Two meta-analyses provide evidence that nurse practioners can deliver care of equivalent quality to that delivered by primary care physicians (Brown and Grimes, 1995; Horrocks et al., 2002)

Say what you will, but I tend to agree with that conclusion.


Brown SA, Grimes DE. A meta-analysis of nurse practioners and nurse midwives in primary care. Nurs Res. 1995;44:332.

Horrocks S et al. Systemic review of whether nurse practioners working in primary care can provide equivalent care to doctors. BMJ 2002; 324:819

 

[MCAT guy]

Um, all of the above?

"which physicians operate off a smaller knowledge base than PCPs?"

I could be wrong, but I'm pretty sure almost no one in any of those fields would even feel entirely comfortable doing a consult for asthma, diabetes, or hypertension.

I concede. You guys are right. PCPs are the most knowledgeable physicians in America and on the planet.

 

[Charles_Carmichael]

Kaushik,

I suspect that you're trying to mislead the public here. How do you figure that PCP is *more* difficult? It has its own challenges, but it's less challenging/rigorous than general surgery. This is common sense for most of us here.

Says who?! NONE of us here have an inkling of what medical training is like. That's why we're in pre-allo. This is absolutely not common sense. Where do you get the idea that any field is more challenging than another field? Competitiveness? That's a poor score to go by...competitiveness, as much as might not want to admit, is based on lifestyle and reimbursements. That's why the most competitive fields (ie. derm, radonc, etc) tend to offer both.

How am I misleading the public? I'm telling you that we have no idea what medical field is "hardest." All I've said so far is that, IMO, a field that requires an incredibly broad knowledge base (such as primary care) is more difficult than specialties that have a narrow scope. Is that really that weird of a concept? Knowing a lot about a lot of stuff is, in my opinion, a lot harder than knowing a lot about a little bit.

What evidence/reasoning do you have to back up what you're stating?

 

[MCAT guy]

Thanks. And I fully respect your stance on this issue as well.

I just personally believe that primary care physicians require the broadest amount of training of any medical field. IMO, the PCPs you know that refer out everything are bad PCPs. A PCP is supposed to be able to handle pretty much everything and refer out in the few instances that they don't have a handle on what's going on. That's the benefit of PCPs: they can handle 99% of the stuff that walks through their doors by themselves. And this definitely does occur at a lot of primary care practices. I would contend that the PCPs referring out a lot are in the minority; however, this is based on anecdotal evidence rather than published literature, so I can obviously be wrong.

I just don't get this underappreciation that present-day society has regarding PCPs.

I appreciate PCPs and their role. I also know they work very hard.

I guess it is best to end this discussion peacefully. I respect everyone's view and I absolutely am open to the idea that I could be wrong. My statements before are based on my current knowledge of the subject.

 

[deleted191570]

I concede. You guys are right. PCPs are the most knowledgeable physicians in America and on the planet.

No, no, you're right, you're right.

PCPs are the intellectual bottom-feeders and least knowledgeable physicians in America and on the planet.

They are definitely more stupid and lazy than everyone else since they couldn't hack it and get into a super-competitive, spend-8-extra-years-in-training-instead-of-working-independently field.

 

[Charles_Carmichael]

Btw, "Two meta-analyses provide evidence that nurse practioners can deliver care of equivalent quality to that delivered by primary care physicians (Brown and Grimes, 1995; Horrocks et al., 2002)

Say what you will, but I tend to agree with that conclusion.


Brown SA, Grimes DE. A meta-analysis of nurse practioners and nurse midwives in primary care. Nurs Res. 1995;44:332.

Horrocks S et al. Systemic review of whether nurse practioners working in primary care can provide equivalent care to doctors. BMJ 2002; 324:819

Are you kidding me? These are the studies you're basing your statements off of?

You have to realize that meta-analyses are only as good as the studies they're reviewing. And the studies that the meta-analyses you cited are reviewing are pretty horribly flawed studies. These completely discredit the findings of these papers...

I've stated many times and I will state again: there is not a SINGLE well-done study that suggests that midlevels provide equivalent care to board certified attendings. There are, however, many horribly designed studies out there using completely useless metrics (ie. patient satisfaction), to say that midlevels = physicians. Anyone who has even a slightly decent background in statistics/experimental design can immediately see these huge flaws (these are not just minor flaws most studies have, btw).

Edit: Just saw your recent post and don't want this thread to degenerate into an NP/DNP vs. MD thread. I respect what you've said.

 

[deleted191570]

They need to know very little about the treatment of any of these diseases. This is why they have to refer patients.

When PCPs refer, they are not relieved of management of those patients... If a given person is seeing three different specialists for three different, highly complex conditions, it's up to the PCP to make sure the patient's care is coordinated-- in order to do this well, they need to know at least something about all of those conditions; and if they don't, well, they probably should take the time to learn which is what makes the job so hard in the first place.

You theoretically need to know a LOT.

Not to mention that specialists can be very hard-line on a lot of treatment methods, and oftentimes it seems like it's up to the PCP to make sure the patient's total care actually makes sense. (i.e., they act as the patient's advocate and representative with specialists)

There should probably NEVER be a situation where a specialist is treating someone without the PCP being informed and in agreement with what's happening

 

[MCAT guy]

No, no, you're right, you're right.

PCPs are the intellectual bottom-feeders and least knowledgeable physicians in America and on the planet.

I never said anything disparaging about PCPs intelligence or lack of knowledge.

When PCPs refer, they are not relieved of management of those patients... If a given person is seeing three different specialists for three different highly complex conditions, it's up to the PCP to make sure the patient's care is coordinated-- in order to do this well, they need to know at least something about all of those conditions; and if they don't, well, they probably should take the time to learn which is what makes the job so hard in the first place.

You theoretically need to know a LOT.

Not to mention that specialists are very hard-line on a lot of treatment modalities, and oftentimes it seems like it's up to the PCP to make sure the patient's total care actually makes sense. (i.e., they act as the patient's advocate and representative with specialists)

I don't think specialists should EVER be treating someone if they aren't in contact with the PCP.

Internet arguing on SDN isn't my bag. I hold an opinion which appears to be slightly different from yours. I respect your view though. And I certainly respect PCPs and the work they do.

Are you kidding me? These are the studies you're basing your statements off of?

You have to realize that meta-analyses are only as good as the studies they're reviewing. And the studies that the meta-analyses you cited are reviewing are pretty horribly flawed studies. These completely discredit the findings of these papers...

I've stated many times and I will state again: there is not a SINGLE well-done study that suggests that midlevels provide equivalent care to board certified attendings. There are, however, many horribly designed studies out there using completely useless metrics (ie. patient satisfaction), to say that midlevels = physicians. Anyone who has even a slightly decent background in statistics/experimental design can immediately see these huge flaws (these are not just minor flaws most studies have, btw).

I in no way meant to anger anyone on this thread. I wish you and any/all PCPs the best. Maybe I was wrong. I apologize if I have offended anyone. In the end, I visit this website to learn more about my career and hopefully to help my future patients.

As for what the future hold?

Let it be.

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