PCP Shortages

[Azmany]

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Is there any glaring holes to this idea that I am missing?

Why don't they seperate gen med (or PCP whatever you want to call it) from other medical schooling. As in, make PCP go through their own college like podiatrists and dentists do? They could cut a year out of schooling, because they would only need basic rounds of other specialists. The gov could supplement funding so cost is much cheaper. It may eliminate some of the nurses from doing an DNP program, because they would have a much better shot of getting in, less debt, and would get better educated.... Basically make it so graduates of the program can only be hospitalists or PCP's thus allowing for many more slots in medical programs for specialists. The reduced schooling and debt would increase the popularity of individuals going into the field of primary care as well....

Any obvious problems with this?

PS I am not sure if this is the right spot, MOD feel free to move

 

[hopki099]

I was hoping this thread would be about the lack of an illegal substance.

 

[guidedwaves]

AFAIK, Texas Tech (MD) has a 3 Yr Family Med Program: http://chronicle.com/article/Texas-Tech-Announces-3-Year/64830/
and LECOM (DO) also has one. Don't really think it's a good idea, but some schools do it.

 

[apumic]

Is there any glaring holes to this idea that I am missing?

Why don't they seperate gen med (or PCP whatever you want to call it) from other medical schooling. As in, make PCP go through their own college like podiatrists and dentists do? They could cut a year out of schooling, because they would only need basic rounds of other specialists. The gov could supplement funding so cost is much cheaper. It may eliminate some of the nurses from doing an DNP program, because they would have a much better shot of getting in, less debt, and would get better educated.... Basically make it so graduates of the program can only be hospitalists or PCP's thus allowing for many more slots in medical programs for specialists. The reduced schooling and debt would increase the popularity of individuals going into the field of primary care as well....

Any obvious problems with this?

PS I am not sure if this is the right spot, MOD feel free to move

Considering the breadth of knowledge a good PCP must have, this sounds like a terrible idea. Shortening the length of training for people going into primary care may sound like a nice idea on the surface but these are the gatekeepers to healthcare. Primary care requires someone with a moderately in-depth understanding of everything instead of being an expert in only 1 thing. The former is probably much tougher to accomplish. If anything, I'd argue for PCPs receiving more training, not less!

 

[Azmany]

Considering the breadth of knowledge a good PCP must have, this sounds like a terrible idea. Shortening the length of training for people going into primary care may sound like a nice idea on the surface but these are the gatekeepers to healthcare. Primary care requires someone with a moderately in-depth understanding of everything instead of being an expert in only 1 thing. The former is probably much tougher to accomplish. If anything, I'd argue for PCPs receiving more training, not less!

But it is better to let DNPs work without supervision in family practice centers like 12 states have done so far? I understand that it is not as desirable, but a 3yr MD training + 1-2 years residency wouldn't suffice? I am only a pre-med so I don't know that answer, I am actually asking.

 

[Azmany]

My point is just, that there are huge shortages in primary care and for the most part an unwillingness of medical graduates to go into it. So why not make a program that is much more desirable, but also better training than the (soon to be) practice of letting DNP's run autonomous clinics?

 

[Charles_Carmichael]

Why don't they seperate gen med (or PCP whatever you want to call it) from other medical schooling.

Um...medical school is general medicine. It's designed to give you a broad exposure to medicine.

So I'm not sure what you're saying here...

 

[Charles_Carmichael]

My point is just, that there are huge shortages in primary care and for the most part an unwillingness of medical graduates to go into it. So why not make a program that is much more desirable, but also better training than the (soon to be) practice of letting DNP's run autonomous clinics?

You seem confused. Primary care isn't unpopular because it's tough to get into med school, which is how I'm understanding your posts.

Primary care is unpopular because of factors like low reimbursements, administrative hassles, the patient population, perceived "prestige," etc.

 

[Charles_Carmichael]

But it is better to let DNPs work without supervision in family practice centers like 12 states have done so far? I understand that it is not as desirable, but a 3yr MD training + 1-2 years residency wouldn't suffice? I am only a pre-med so I don't know that answer, I am actually asking.

Just because nurses have a powerful lobby and have gotten their way in a bunch of states doesn't mean it's the right thing to do. I'm still waiting for a prospective trial comparing physicians vs. independent NPs/DNPs (without physician back-up) that's properly designed. It's unlikely to ever happen though.

I agree with apumic that PCPs require a very broad knowledge base. If anything, I would argue for increasing the length of training (and I think the AAFP has, in recent times, considered extending residency by an additional year).

When you have to know a lot about a lot of different things, why would you cut down on the training? It doesn't make any sense.

 

[Azmany]

You seem confused. Primary care isn't unpopular because it's tough to get into med school, which is how I'm understanding your posts.

Primary care is unpopular because of factors like low reimbursements, administrative hassles, the patient population, perceived "prestige," etc.

You missed about half of my post. Easier admissions, lower schooling costs, less time in residency all would be reasons one would want to go into primary care. It basically would be a way to be a doctor for those who didn't necessary have the academic requirements to get in, but with higher standards than some of the alternative programs. Also it would increase the amount of physicians graduating every year to lessen the gap.

I find it funny that all the responders are pre-meds talking about how important interning is. Unless it's just that none of you update your status. I have shadowed two PCP's and 90% of what I saw was fairly routine medical stuff that I knew from Pharmacy school. 9% was referred out to specialists and the remaining was something that seemed to require a more indepth knowledge.

 

[lonewolf1513]

OP here is the thing about family medicine. It doesn't pay enough for the hours you have to put in, but some people still love it and go into it. As for your comment of going through pharmacy school and knowing as much a PCP is well insulting. Just like many other professions, i can just say all pharmacists have to do is fill the drugs (what the physician wrote), but obviously there is a lot going on in that brain. So what you see up front is probably just the tip of the iceberg. Cutting down rotations in my opinion makes a PCP pretty bad, because they don't get an exposure to other specialties. If they don't realize what others can do they can't recommend others properly, lengthening the red tape. If you look at certain trends as of now you will see how more physicians (internalists, PCP, GP, etc...) are choosing to work less, or are just taking cash patients. Which is actually giving them a pretty good income, considering physicans loose more money due to insurance and government underpaying. So lets see what the future brings, who knows maybe in the future being a PCP will be a top specialty (it used to be at one time or another :-? )

 

[Charles_Carmichael]

You missed about half of my post. Easier admissions, lower schooling costs, less time in residency all would be reasons one would want to go into primary care. It basically would be a way to be a doctor for those who didn't necessary have the academic requirements to get in, but with higher standards than some of the alternative programs. Also it would increase the amount of physicians graduating every year to lessen the gap.

I find it funny that all the responders are pre-meds talking about how important interning is. Unless it's just that none of you update your status. I have shadowed two PCP's and 90% of what I saw was fairly routine medical stuff that I knew from Pharmacy school. 9% was referred out to specialists and the remaining was something that seemed to require a more indepth knowledge.

And you've been missing the point all of us have been trying to make.

Why should admissions be easier for this hypothetical primary care only school? PCPs, like has been mentioned several times, need to know a lot about a broad number of topics. The breadth of knowledge one needs to have in order to be a good (not mediocre) PCP is immense. At least, that's what makes logical sense to me (med students/residents/attendings can feel free to correct me if I'm wrong here). So, why should you dilute the caliber of entering students? You should have stringent measures put in place to ensure that the students accepted will finish the program just like med schools do. The gatekeeper is the admissions process rather than getting weeded out during the schooling itself, which would leave you with a lot of debt and wasted time.

It would increase the number of graduating physicians each year to lessen the gap? I really have no clue what you're talking about here. By around 2016 (IIRC) there will be more graduating medical students each year than there are residency spots available. And without residency, how are you going to practice independently?

And, like it was mentioned several times, why do you want to decrease the amount of training PCPs need? It makes absolutely no logical sense. When you have to know a lot about a lot of things, it doesn't make sense to make training shorter than the current gold standard.

And before pointing out that all of us are premeds, aren't you one as well? And aren't you making assumptions such as shorter training = 4 years of med school + residency, etc? A little hypocritical, don't you think?