What is the easiest solution to the primary care shortage? My thoughts inside.

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touchpause13 said:
When Ya'll make an AMA for this guy please someone tag me.

Good Lord man
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Me as well. I've had a hell of a time trying to balance my cynicism and honest, genuine advice with mrh125. Makes me wonder what that mr stands for at times...
 
WillburCobb said:
Me as well. I've had a hell of a time trying to balance my cynicism and honest, genuine advice with mrhc. Makes me wonder what that mr stands for at times...
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His behavior bounces back and forth between amiable and contributive, to this kind of thing. Aside from the presentation, working to incentivize students to go into primary care is an important issue. The shortage is serious. After a year working at a free clinic, I know first hand what a lack of regular, standard care can do to a person. Some people just start falling apart.
 
J Senpai said:
His behavior bounces back and forth between amiable and contributive, to this kind of thing. Aside from the presentation, working to incentivize students to go into primary care is an important issue. The shortage is serious. After a year working at a free clinic, I know first hand what a lack of regular, standard care can do to a person. Some people just start falling apart.
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It's hard to stay positive about medical school and this whole process non-stop especially mcat changes. I try and help out when I can, but there are bits of the process that really bug me and demotivate me and I don't think are fair. I try and find out about the process so I can look at it in a more positive way. Realistically the only thing to do is just try our butts off the hardest we can and hope for the best. I just wish there more safety and stuff to hold onto. Trying the hardest we can to end up not being able to achieve what we set out to. It's a learning experience but still.
 
J Senpai said:
His behavior bounces back and forth between amiable and contributive, to this kind of thing. Aside from the presentation, working to incentivize students to go into primary care is an important issue. The shortage is serious. After a year working at a free clinic, I know first hand what a lack of regular, standard care can do to a person. Some people just start falling apart.
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I agree 100%. I honestly feel really bad for turning down offers to cover my tuition if I go into primary (especially after seeing its need first hand), but I have a really strong interest in psych and end of life issues. These are issues that are equally as important, un-addressed, and burdensome on our healthcare system but unfortunately don't get the attention they deserve. I'm tired and not sure where I'm going with this but yeah...
 
WillburCobb said:
I agree 100%. I honestly feel really bad for turning down offers to cover my tuition if I go into primary (especially after seeing its need first hand), but I have a really strong interest in psych and end of life issues. These are issues that are equally as important, un-addressed, and burdensome on our healthcare system but unfortunately don't get the attention they deserve. I'm tired and not sure where I'm going with this but yeah...
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Jeez no wonder I like you. I hope you do go for psych. ND needs so many more psychiatrists
 
This is an easy one. Just make it so that every doctor gets paid the same, whether they are a plastic surgeon in LA or a family med doc in rural Wyoming. Everyone gets paid the same, so more people are likely to go into primary care since it's a shorter residency. Problem solved. 😉
 
touchpause13 said:
Jeez no wonder I like you. I hope you do go for psych. ND needs so many more psychiatrists
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Psych or end of life care (either CCM or palliative) is what I'm aiming towards. Don't even get me started on mental health needs in nodak...my rants will have no end. We're definitely f-ed in this area.
 
NavyDoc23 said:
This is an easy one. Just make it so that every doctor gets paid the same, whether they are a plastic surgeon in LA or a family med doc in rural Wyoming. Everyone gets paid the same, so more people are likely to go into primary care since it's a shorter residency. Problem solved. 😉
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What is this? The Soviet Union? Screw that noise I'd never become a doc in that type of system
 
touchpause13 said:
What is this? The Soviet Union? Screw that noise I'd never become a doc in that type of system
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What?! You mean you wouldn't want to work in a communist-like healthcare system!!!???
 
@touchpause13 What is truly ridiculous is that there are those who advocate for that kind of thing. My mama taught special ed for 23 years; she heard that bleeding heart nonsense all the time. Administration seemed to think so too, as she was often forced to work Saturday events without pay. I've seen it first hand. They fully expect these worked-to-the-bone teachers to do extra crap for free.
 
touchpause13 said:
What is this? The Soviet Union? Screw that noise I'd never become a doc in that type of system
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Hey now, the commies know how to throw a party
636x460design_01.jpg
 
mrh125 said:
I was bitter about the 2015 mcat changes before I even took my mcat and got my score. It's more about the extremes and extraordinary amount of pressure it puts on students that is so unnecessary that bothers me. people need to enjoy their damn lives.
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I'm gonna take the 2015. Bit bummed that its 7 hours but at least we get a lunch break to recollect ourselves. Really, the MCAT occupies 0% of my daily thinking and I'm going to start studying this summer.

Then again, I'm a liberal arts major so I've lived and breathed the new stuff for a while.
 
Lucca said:
I'm gonna take the 2015. Bit bummed that its 7 hours but at least we get a lunch break to recollect ourselves. Really, the MCAT occupies 0% of my daily thinking and I'm going to start studying this summer.

Then again, I'm a liberal arts major so I've lived and breathed the new stuff for a while.
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That's good. The new sections are supposedly like mini verbal reasonings,
So you're pretty well prepared.
The biochem section looks awful though. It requires way more nitpicky memorization. Like all the pkas of amino acids functional groups and all the intermediates in the krebs acid cycle.
 
WillburCobb said:
Me as well. I've had a hell of a time trying to balance my cynicism and honest, genuine advice with mrh125. Makes me wonder what that mr stands for at times...
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I don't get the whole the one mh stands for inside joke. Explain
 
darklabel said:
Make personal statements binding. Then suddenly competitive specialties would have little competition and FM/IM would be the next hottest thing.

http://www.gomerblog.com/2014/01/ma...ed-school-personal-statement-legally-binding/
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Now that's an idea haha!

So I can't pretend to even know the slightest thing about the ins and outs of different specialties, so maybe an experienced med student or a physician could enlighten me about a few things. Why couldn't we shorten medical school or make it cheaper for those wanting to go into PC? For instance, suppose you find that during your rotations you're really digging PC and would like to go down that route. Could there be a kind of "out" in which you apply for residency spots in Nov/Dec to match at the end of the third year? You're going into PC, so do you really need that 4th year? Most people apparently spend it doing rotations in specialty fields anyway. It would save med students 1/4 of the cost + interest on those loans, and we could couple the same sort of tuition reimbursements to these positions, but there would be less tuition to reimburse (thus more students reimbursed). There would have to be some way to ensure you wouldn't sub-specialize afterwards of course.

Now an even crazier idea. Could we instead create separate programs for PC MD only? For instance, you apply to med school and don't get in anywhere, but maybe a few schools give you an accelerated PC option. Here you'd cut out the 4th year of med school and replace it with an accelerated program that incorporated more PC-oriented rotations (and fewer training resources/lower tuition cost), which would allow slight cuts in tuition, but still complete an internship+residency. You could reduce cost to maybe 2/3 of what it is now, increase incentive for going into PC (bc some students have no other options), and still have fully trained doctors having gone through MS3 as well as an internship + residency.

This is where I really need a doctor's input. Obviously you want to avoid just making a program between PA/NP and actual MD, that's why you'd try to cut med school time/tuition cost and not the residency training time. Is there room in a medical school curriculum to cut the fluff for future PC docs and graduate in 3 years? Would there be a trust/superiority problem in the hospital when PC MDs shared patients with the specialized MDs? Would medical schools miss the extra tuition too much?
 
^ There are already some 3-year straight to primary care programs out there. Mercer in Georgia is one, I remember seeing something about NYU and Texas Tech as well. These are for Family Medicine. But I am fairly sure you have to be accepted to these coming in, you can't just opt in at the end of third year. That's an interesting idea, but taking out a whole year of rotations for a specialty as broad as FP seems like you would lose quite a bit. But I haven't been through fourth year so I can't speak much to its value.
 
dap said:
^ There are already some 3-year straight to primary care programs out there. Mercer in Georgia is one, I remember seeing something about NYU and Texas Tech as well. These are for Family Medicine. But I am fairly sure you have to be accepted to these coming in, you can't just opt in at the end of third year. That's an interesting idea, but taking out a whole year of rotations for a specialty as broad as FP seems like you would lose quite a bit. But I haven't been through fourth year so I can't speak much to its value.
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Neither can I. I've heard the sentiment around here that 4th year is a time to get exposed to the specialties, and I've even heard some medical students resent that they even have to pay for it. I was thinking something along the lines of an accelerated pre-clinical curriculum that started to incorporate rotations earlier. You'd cut out elective rotations like derm, ortho, etc... and replace all those spots with one or two rotations in PC-oriented programs. My understanding is that the NYU program allows certain accepted students to graduate in 3 years as long as they pick their specialty right away. This seems to suggest that if you know what you want, a sufficient education could be attained in 3 years. So why not turn this concept into a solution for the primary care shortage? Accelerated and cheaper medical education for students who decide on PC from the start, or even certain slots held in schools for these cheaper 3 year programs.

Like I said, I have no idea what I'm talking about, so someone with experience in the field and a good understanding of medical economics will have to back me up (or shut me down).
 
So people say it's the money, but most family medicine and pediatrics I have gone to they have contracts all over the place. Today I'm going to go get my yearly physical and this doctor has 5 locations he goes to. 😱
 
EngineerPreMD said:
Now that's an idea haha!

So I can't pretend to even know the slightest thing about the ins and outs of different specialties, so maybe an experienced med student or a physician could enlighten me about a few things. Why couldn't we shorten medical school or make it cheaper for those wanting to go into PC? For instance, suppose you find that during your rotations you're really digging PC and would like to go down that route. Could there be a kind of "out" in which you apply for residency spots in Nov/Dec to match at the end of the third year? You're going into PC, so do you really need that 4th year? Most people apparently spend it doing rotations in specialty fields anyway. It would save med students 1/4 of the cost + interest on those loans, and we could couple the same sort of tuition reimbursements to these positions, but there would be less tuition to reimburse (thus more students reimbursed). There would have to be some way to ensure you wouldn't sub-specialize afterwards of course.

Now an even crazier idea. Could we instead create separate programs for PC MD only? For instance, you apply to med school and don't get in anywhere, but maybe a few schools give you an accelerated PC option. Here you'd cut out the 4th year of med school and replace it with an accelerated program that incorporated more PC-oriented rotations (and fewer training resources/lower tuition cost), which would allow slight cuts in tuition, but still complete an internship+residency. You could reduce cost to maybe 2/3 of what it is now, increase incentive for going into PC (bc some students have no other options), and still have fully trained doctors having gone through MS3 as well as an internship + residency.

This is where I really need a doctor's input. Obviously you want to avoid just making a program between PA/NP and actual MD, that's why you'd try to cut med school time/tuition cost and not the residency training time. Is there room in a medical school curriculum to cut the fluff for future PC docs and graduate in 3 years? Would there be a trust/superiority problem in the hospital when PC MDs shared patients with the specialized MDs? Would medical schools miss the extra tuition too much?
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http://www.nejm.org/doi/full/10.1056/NEJMp1304681

I see that others have already responded, but an article never hurts :droid:
 
mrh125 said:
Increasing the level of technical skill and technical requirements to be a primary care doctor thereby allowing them to do more in-patient procedures would incentivize and justify them being paid more. This logic comes from looking at how most of the higher paid specialities require greater technical skill, often times responsibility, and pressure. You're definitely right about the reimbursement scheme though.
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There's a reason that they have lost those procedures except in rural areas. This isn't the 1950s.
 
Mad Jack said:
🤣:roflcopter:😆🤣
No, just no. The new requirements aren't meant to be predictive of primary care potential in any way whatsoever.
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Pretty sure he was being sarcastic.
 
masaraksh said:
What if the NRMP, The US Government, and Porsche of America create an initiative for everyone that if you match to primary care it comes with a Porsche (that seems to be important for many based on the other threads). Like, the keys come in the same envelope as the match letter in March.
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Great, so they can have great ride to work, to take them to a job they hate.
 
mrh125 said:
It's hard to stay positive about medical school and this whole process non-stop especially mcat changes. I try and help out when I can, but there are bits of the process that really bug me and demotivate me and I don't think are fair. I try and find out about the process so I can look at it in a more positive way. Realistically the only thing to do is just try our butts off the hardest we can and hope for the best. I just wish there more safety and stuff to hold onto. Trying the hardest we can to end up not being able to achieve what we set out to. It's a learning experience but still.
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If you're having a hard time "staying positive" now, just wait till you enter and go through medical school. You've seen nothing yet.
 
masaraksh said:
Well, it can't be that everyone hates primary care?
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Yes, not everyone hates primary care. In fact, Pediatricians tend to be very satisfied (not surprising as it's very gratifying to help sick children). Unfortunately, surveys bear out that General IM and Family Med docs tend to be the most dissatisfied and unhappy with their specialty.

HappinessFactorChart-532x630.png
 
DermViser said:
Yes, not everyone hates primary care. In fact, Pediatricians tend to be very satisfied (not surprising as it's very gratifying to help sick children). Unfortunately, surveys bear out that General IM and Family Med docs tend to be the most dissatisfied and unhappy with their specialty.

HappinessFactorChart-532x630.png
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Freakin' dermatologists. Every time. 😛

Compensation for these providers is probably the biggest deterant. From what I've been told, many people match into FP and lower IM because that's just what they got. It appears that pediatricians generally know what they're getting into, when they make the "I want to save the children" decision. They're just going to be happy with their work, as it's more often than not a special calling.
I would imagine that the FP working 70 hr weeks who sees his rads friend work 50 hrs a week and take in 250k+ gets a bit dissatisfied. Mo money for PCPs, pls.
 
275k+ for primary docs and loan forgiveness with NO strings attached = problem solved... Hmmm! I wonder what the average step1 score will be if there are these incentives.
 
Restructure primary care so each practice consists of more PAs than MDs. Make PAs the first line and give the more important cases to the MDs.
 
J Senpai said:
Freakin' dermatologists. Every time. 😛

Compensation for these providers is probably the biggest deterant. From what I've been told, many people match into FP and lower IM because that's just what they got. It appears that pediatricians generally know what they're getting into, when they make the "I want to save the children" decision. They're just going to be happy with their work, as it's more often than not a special calling.
I would imagine that the FP working 70 hr weeks who sees his rads friend work 50 hrs a week and take in 250k+ gets a bit dissatisfied. Mo money for PCPs, pls.
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To be fair, I also think it's the environment. Look at Google Images at how nice children's hospitals are in comparison to adult hospitals: http://www.google.com/search?q=children's hospitals&source=lnms&tbm=isch&sa=X&ei=RMVfU9aRHcma2AW4o4C4BA&ved=0CAgQ_AUoAw&biw=1242&bih=568

As a society, it's against our moral fiber to let a vulnerable population such as children, be left to fend for themselves. I think general pediatricians and pediatric subspecialists are very much gratified by what they do bc they can truly make a difference in a child's life, who has many great years ahead of them.

To be fair, Rads is no longer a 9-5 specialty, esp. for new grads.
 
DrHart said:
Restructure primary care so each practice consists of more PAs than MDs. Make PAs the first line and give the more important cases to the MDs.
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So your solution to primary care is for primary care doctors who spent 4 years of college + 4 years of med school + 3 years of residency, to essentially be administrators and only work on the complex, difficult cases which tend to have worse outcomes on average. Oh yeah, that will definitely increase the level of satisfaction. 🙄
 
WillburCobb said:
M is short for mental...
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wow you're ****ing hilarious, bro

DermViser said:
If you're having a hard time "staying positive" now, just wait till you enter and go through medical school. You've seen nothing yet.
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I know, that's what I'm trying to prepare the hell out of myself and anticipate what i'm up against. I'm going to achieve my goals, but this entire process is a massive pain in the butt.
 
BestDoctorEver said:
What part of the country is that?
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Nodak. There's a severe maldistribution of mental health workers here which leads to increased demand and horrendous work loads for those who choose to practice here. I personally know a psychiatrist who negotiated a salary close to $300K in his home town close to all of his family and the hospital agreed to cover his student debt if he stayed for x number of years. Once the contract was up he bailed for a position that paid much less in a location with a considerably higher cost of living. I've heard numerous psychiatrists here mention that they had it better workload and call wise in residency.
 
Pay PCP physicians >2 hours from a major metro literally $1 million/year. That's the only way. Most educated professionals don't want to live in the middle of nowhere.
 
J Senpai said:
@touchpause13 What is truly ridiculous is that there are those who advocate for that kind of thing. My mama taught special ed for 23 years; she heard that bleeding heart nonsense all the time. Administration seemed to think so too, as she was often forced to work Saturday events without pay. I've seen it first hand. They fully expect these worked-to-the-bone teachers to do extra crap for free.
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SERIOUSLY?!?!!?
 
WillburCobb said:
I agree 100%. I honestly feel really bad for turning down offers to cover my tuition if I go into primary (especially after seeing its need first hand), but I have a really strong interest in psych and end of life issues. These are issues that are equally as important, un-addressed, and burdensome on our healthcare system but unfortunately don't get the attention they deserve. I'm tired and not sure where I'm going with this but yeah...
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Psychiatry is just as critical and just as underserved as primary care. You shouldn't feel bad at all.
 
WillburCobb said:
I agree 100%. I honestly feel really bad for turning down offers to cover my tuition if I go into primary (especially after seeing its need first hand), but I have a really strong interest in psych and end of life issues. These are issues that are equally as important, un-addressed, and burdensome on our healthcare system but unfortunately don't get the attention they deserve. I'm tired and not sure where I'm going with this but yeah...
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Don't feel bad one bit. If anything, they should feel bad for not including Psychiatry under primary care esp. with current events of mass shootings.
 
mrh125 said:
It's sarcastic and a jab at the 2015 mcat. I really don't like how they're changing it and how much (arguably unnecessary) stress it will put on students in my perspective, but I do recognize the benefits of making it more similar to the USMLE exams in terms of their duration. There should be more to premeds lives' than having to put everything into their future in medicine and as an undergraduate who was consumed by the process for a long period of time, it's a huge issue imo. People really need time to enjoy their lives and enjoy the perks of being a college student/young adult and taking away that part of their life bothers me.
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Speaking of, this made me want to vomit: https://www.aamc.org/newsroom/reporter/march2012/276772/word.html

One of the biggest changes to the test in 2015 that will help medical schools make this assessment is a new section, the “Psychological, Social, and Biological Foundations of Behavior.” Testing students’ understanding of these areas is important, because being a good physician is about more than scientific knowledge. It is about understanding people—how they think, interact, and make decisions. Together with a solid foundation in the natural sciences, an understanding of behavior, perception, culture, poverty, and other concepts from psychology and sociology all contribute to the well-rounded physician. Of course, we want our doctors to understand how chemical compounds interact so our prescriptions do not have adverse interactions. But we also want our doctors to have good bedside manner, communication skills, and an ability to interact with people. After nearly 60 years, I still remember my pediatrician, Dr. Bramley—not for his class rank or MCAT exam score, but for his kindness, compassion, and how much he truly cared.

And what better way to measure kindness, compassion, and whether one truly cares, than on a multiple choice exam.
 
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DermViser said:
So your solution to primary care is for primary care doctors who spent 4 years of college + 4 years of med school + 3 years of residency, to essentially be administrators and only work on the complex, difficult cases which tend to have worse outcomes on average. Oh yeah, that will definitely increase the level of satisfaction. 🙄
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Why is satisfaction an issue? Doctors choose the area they want to go into. You could be dissatisfied with the amount of hours and low pay in the current system. Or you could handle the harder cases and spend more time doing administrative work. Or if you're smart you don't go into primary care. There is no simple answer in which everyone wins. If you restructure the current system to fit the demands- a PA based primary care practice would work. The current system doesn't.
 
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