Why are primary care physicians looked down upon?

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coolness

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Is it because they earn lower salaries than specialists? Or is it because specialists can do what primary care physicians do?

Also, are there any instances where a specialist would refer a patient to a primary care physician?

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IMHO, the only ones who look down on "Primary care docs" are ignorant patients, clueless pre-meds, and naive (MS-1/MS-2) medical students.

I never seen a doctor or a resident look down on other doctors b/c of their specialities (except maybe EM doc ;) ) Every one in the real world knows the limits of their practice. A Cardiologit might still remember how to manage a person with ARDS , but is more "comfortable" refering the patient to pulmonologist. A surgeon might know the basics of how to manage patients on the floors, but they a not the best at it, and therefore leave the job for the general IM doctors.

Specialists, in general, are not comfortable seeing a patient off the street who have not been seen by a Primary care physician, and who does not have a list of preliminary diagnosis yet. The impression I get is that specialist do not see themselves are "diagnostitions" (sp?), they are consultants.

In the real world, everyone respects each other b/c they know their limits.
Just ask an Orthopod to give you his impression of an EKG. You will be surprised my friend. ;)
 
While I would not refer a patient to a PCP for a surgical issue, every patient I discharge gets a letter to his PCP and is told to follow up with their PCP within the week for general medical issues. Patients without PCPs are kindly told that they need to get one and that I can have our Case Managers assist them with that if they desire.

I am well aware that PCPs are much better at long term management of HTN, DM, COPD, etc. than I am and would not derogate them. I am comfortable treating those things (for the most part) while the patient is in-house, but for outpatient care, he/she is MUCH better served by a PCP. I frankly appreciate that there are people who want to do this for a living, just as I'm sure they're glad someone (else) wants to be a surgeon (as they sure don't).
 
Leukocyte said:
I never seen a doctor or a resident look down on other doctors b/c of their specialities (except maybe EM doc ;) )

We don't look down on PMDs. Most of us feel that a HUGE percentage of ER patients could be managed in a PMD office if they would just give them an urgent appointment. I'm the first to admit that I'm not a good PMD. I'm not trained for it and I can't deliver it from the ED. And as for other specialists they can't do squat on their own. If a pt has DM or HTN, admit that to medicine.
 
I think there is a perception in academic settings and other very large institutions that FP is on a lower tier somehow. In these settings, the attendings tend to be the most competitive and are big cheerleaders for their specialty...there will always be that kind of competition, from high school sports and throughout the rest of life. Also, the PCP's have their hands tied; referrals must stay within the institution, or there is political hell to pay.
However, in pvt practice, PCP's control referrals, so the specialists tend to court them instead. The contrast is astounding...specialists call back with thanks, go out of their way to take your call and get your patient in on a walk in appt. During the Christmas season PCP clinics are flooded w/ bottles of wine, fruit baskets and other swag. Pompous specialist who move into a community setting soon learn the new rules of the game, or suffer financially.
 
Leukocyte said:
Just ask an Orthopod to give you his impression of an EKG. You will be surprised my friend. ;)
It might be something with finger-tracing gestures and sound effects, like:

"BEEP squiggle squiggle squiggle BEEP squiggle squiggle squiggle BEEP..."

or

"I don't do impressions. My training is in medicine."

Ortho and EM, in my humble experience, are where the jokesters tend to make themselves known. And to the OP, I've heard all manner of specialists sigh and wish docs in other specialties understood their area better, but I've never heard anyone derogate (cool word bonus to K.Cox) another physician just because of their chosen field.
 
coolness said:
Is it because they earn lower salaries than specialists? Or is it because specialists can do what primary care physicians do?

Also, are there any instances where a specialist would refer a patient to a primary care physician?

I don't know about you guys, but my experience with FP's has made me look down on them as generally being lazy and incompetent. Ofcourse this isn't true for most FP's, but it's a high enough percentage to make a strong association. Maybe it's b/c so many FP's went to medical school in different countries and didn't get as good an education or something, but there sure are a lot of idiots in this field.

During my FP rotation I was pretty surprised that some of the FP's didn't even know the most basic things and routinely misdiagnosed everything, overprescribed abx, repeatedly sent the same patients with GERD for multiple cardiology consults, told patients with thyroid FNA's showing follicular cells that it was benign and they didn't need a bx, etc, etc, etc.

Also, many FP's pretend to know stuff they don't and that's why their diagnoses are frquently so wrong. As a personal example, my knees are permantly F*cked up b/c of my stupid FP doctor misdiagnosing them and basically LYING about not knowing what was going on. It wasn't until I got to medical that I figured out he'd been bullsh*ting me for the past year. When I rotated in FP, I saw that his behavior was the norm though. In fact, he's much smarter then a lot of the ******s I've seen in FP who's medical knowledge is about 10 years outdated.
 
Hi there,
Since all of my referrals will come from primary care docs, I cannot look down upon them. A good primary care physician is worth their weight in gold. Like Kimberli, I send a copy of my op report and dischage summary to every primary care doc. I also look to them to do things like manage anticoagulant therapy too.

Good primary care medicine is very difficult to do. Too many times, some of the worst physicians end up in primary care because they can't do anything else and the patients suffer. Most of the time, it has been my experience that the primary care folks appreciate what we do and I certainly appreciate what they are able to do.

njbmd :)
 
I don't know about you guys, but my experience with FP's has made me look down on them as generally being lazy and incompetent.

While we're throwing down personal experience as evidence, let me say that where I did my FP rotation the docs were very on the ball about EBM and taught me a thing or two about treatments and conditions I thought I had down cold.

C
 
Febrifuge said:
but I've never heard anyone derogate (cool word bonus to K.Cox) another physician just because of their chosen field.

One word:
PSYCHIATRY. :thumbdown:
 
Sledge2005 said:
I Maybe it's b/c so many FP's went to medical school in different countries and didn't get as good an education or something, but there sure are a lot of idiots in this field.
.

A ******ED STATEMENT FROM THE SAME DOUCHEBAG THAT BROUGHT US THIS PEARL.
Sledge2005 said:
Okay, so I'm on home call on a Friday night. Why shouldn't I have a beer? It's not like I'll be doing anything important if the resident calls me, mainly I'd just be shadowing him!
Get a life, prick.
If you want to rail on FP's, go ahead. You have some really bad stories, and therefore you have worked with some real $hitty doctors at your medical school, THat reflects on YOUR education, so dont bring IMGs into it. The vast majority of FP/PC docs in the US are Americans.

Fool. :thumbdown:
 
What about ER docs? It seems like they get criticized a lot for things like frequently referring to other specialists.
 
MustafaMond said:
A ******ED STATEMENT FROM THE SAME DOUCHEBAG THAT BROUGHT US THIS PEARL.

Get a life, prick.
If you want to rail on FP's, go ahead. You have some really bad stories, and therefore you have worked with some real $hitty doctors at your medical school, THat reflects on YOUR education, so dont bring IMGs into it. The vast majority of FP/PC docs in the US are Americans.

Fool. :thumbdown:

LOL, is the quote from my non-serious lounge post that best you can do? You're so ******ed that you'll fit right in with the FP's who attended medical school mexico that I had the distinct displeasure of working with. All the they'd talk about was stuff like how patients liked doctors better who took their blood pressure personally, or touched them on the shoulder. Meanwhile they couldn't even dx tennis elbow.
 
Seaglass said:
While we're throwing down personal experience as evidence, let me say that where I did my FP rotation the docs were very on the ball about EBM and taught me a thing or two about treatments and conditions I thought I had down cold.

C

I never said they were all bad, most aren't. In fact, a lot of FP's that worked with were great! However, the percentage of horrendous doctors in FP seemed much higher then any other field I've rotated in.
 
Sledge2005 said:
You're so ******ed that you'll fit right in with the FP's who attended medical school mexico that I had the distinct displeasure of working with. All the they'd talk about was stuff like how patients liked doctors better who took their blood pressure personally, or touched them on the shoulder.

That's pretty funny stuff.
Touche. :thumbup:
 
coolness said:
What about ER docs? It seems like they get criticized a lot for things like frequently referring to other specialists.

Yeah, we take a lot of crap. Every pt we see will eventually be seen by someone else, PMD or Admit doc or specialist. That's why we call the ER "the fish bowl" however once you're out of residency and away from the academic center the PMDs, specialists and so forth have to wotch themselves because they still want to be able to dump pts on the ED that they do not want to work up, or that they want to have admitted.
 
Specialists look down on PCP's because PCP's don't have the depth of knowledge in that specialty as much as the Specialist does. When PCP's can't figure something out, they consult/refer... and when the patient lands in the specialists' hands, they think "why the hell don't you know that?"... And so because PCP's are all different and some are better at some things than other things, Specialists end up getting consults/referrals that are either incompletely worked up and misdiagnosed.

Of course, there are some really good PCP's who don't know the answer to a problem, work the patient up to the end, and then refer patients to see a specialist. But even then, you can't win because some specialists get pissed when you consult them late...

So the key thing about being a PCP, I think is knowing who and when to consult and have a plan.

Remember, PCP because they see the GENERAL population are trained to treat common diseases... but specialists are trained to find the Zebra Syndromes.

The funny thing is when patients land on Specialty services in the hospital and the docs have no idea what the hell is going on... and it results in the PCP service (either IM, Ped, FP) getting dumped by the Specialty. OR even worse yet, you have people who THINK they're good at EVERYTHING, like OB/GYN, and try to manage everything and end up not being good at anything.
 
man, that sure is a different attitude from residency. You try to transfer or consult different specialty services in my hospital, and half the residents squeak and bitch and moan. The other half are generally very nice. I guess thats not unexpected when there is no financial incentives...

bente said:
I think there is a perception in academic settings and other very large institutions that FP is on a lower tier somehow. In these settings, the attendings tend to be the most competitive and are big cheerleaders for their specialty...there will always be that kind of competition, from high school sports and throughout the rest of life. Also, the PCP's have their hands tied; referrals must stay within the institution, or there is political hell to pay.
However, in pvt practice, PCP's control referrals, so the specialists tend to court them instead. The contrast is astounding...specialists call back with thanks, go out of their way to take your call and get your patient in on a walk in appt. During the Christmas season PCP clinics are flooded w/ bottles of wine, fruit baskets and other swag. Pompous specialist who move into a community setting soon learn the new rules of the game, or suffer financially.
 
I think you're overlooking the sad but obvious. In this country money=prestige. PCPs almost always make less money than specialists. When the cardiologist rolls up in the Escalade and sees the FP putter in with his Camry, Cards puffs himself up and thinks: That guy must be an idiot to do FP.

In an enormous overgeneralization, I think primary care medicine tends to make you humble while specialists (especially ones that do procedures) have a tendency to become more arrogant. Who wouldn't be arrogant after saving someone's life with a CABG, PCTA, Whipple or whatever? PCPs get **** on by insurance companies, patients, administrators, while those same groups fall all over themselves to please the CT surgeons, orthopods, GI docs, etc.

EM docs are sort of on the threshold between PCPs and specialists, IMHO. I do a lot of primary care medicine in my day (adjust HTN meds, treat minor aches and pains, etc), but everyone once in awhile I get to resuscitate a patient, intubate and central line, and then dump on the ICU/IM doc.
 
beyond all hope said:
..........................., and then dump on the ICU/IM doc.

Well, THANK YOU, you ****-**** ER ****-***** "doctor". :laugh:
 
Why are primary care physicians looked down upon? <

Because this is their idea of brilliance.
 
I didn't. I was reading essays in Medical Economics and was linked to this one. It's amusing.
 
lowbudget said:
OR even worse yet, you have people who THINK they're good at EVERYTHING, like OB/GYN, and try to manage everything and end up not being good at anything.

I don't know about your region, but in MY neck of the woods, the reason OB/GYN tries to manage everything by themselves, because they have been FORCED TO DO SO by these specialists who REFUSE to consult on a patient that happens to be pregnant. The fear of the pregnant patients and the perceived liability risk, results in the majority of docs here who don't even want to LOOK at a pregnant patient. Good luck finding an Internist, oncologist, GI, or cardiologist willing to see a pregnant patient, cause you WON'T FIND ONE HERE. Thus OB/GYN has been made to fend for themselves, so don't blame them for trying to do everything by themselves, cause they have no choice.

-Derek
 
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