What I think everyone has to remember is that the population who tends to show up in doctor's offices the most are attention seekers with silly complaints which probably everybody else has, but they don't obsess about it. Sure, not everyone is like this, but if you were such a person, where would you go to satisfy your need for an authority figure to take care of you? MDs office of course, because nobody else would tolerate this nonsense.
A specialist has the advantage of limiting their interactions with these individuals. Whereas, a primary care MD becomes a surrogate mother/father.
Here's an anecdote to show you what I mean. I have a friend who is an FP. He gets a call at 3 AM from a patient whose electricity was turned off because the patient didn't pay the bill in two years. The patient says to the FP that she is thinking of killing herself because the power is off. So the FP has to call the power company and beg them to turn the power on for the night.
No cardiologist or GI or surgeon would have to deal with that.
I agree with this. Though this was an extreme example, it shows one of the problems in primary care. One of my reasons for not doing primary care is that I don't want to deal with drug seeking patients for the rest of my life. In cardiology, I can tell the patient if they don't have cardiac pain, there's no medical indication for me to keep giving them narcotics, and that's it. No argument, no "But doctor, you don't CARE how I SUFFER!!! I'm going to complain to the medical board that you wouldn't treat my PAIN!".
I don't think most people decide not to do primary care out of greed/wanting more money. I'm sure that factors in for some, but internal med still does all right...IF you are willing to be an employee, or if you are a very good businessperson and practicing in the right area of the country. Small 1-4 doc private practices are not doing well in general in most places...they have to work more and more hours seeing more and more patients to keep their income near where it was a few years ago. Many fear for the future of primary care as a career for physicians, since the gov't may take things over and decide it's cheaper to just use NP's/PA's for this and decide to do so.
I disagree that primary care is routine/algorithmic, any more so than most other specialties. Internal med, in particular (because we tend to see many older patients with multiple medical problems) is not "easy" per se, although of course outpatient medicine is easier than inpatient medicine, in the sense it is hard to hurt/kill a patient who isn't very sick. You CAN however, harm a patient by not giving the correct treatment, not doing cancer screenings, not realizing who is really sick (vs. wimpy, anxious or malingering, etc.).
There IS more paperwork in primary care vs. most other specialties, particular in HMO type situations, because the primary doc is the final common pathway to fill out family/medical leave paperwork for the patients, their family members, give out handicapped parking stickers, get the patient a power scooter from Medicare, fill out wound care orders on a patient because the surgeon who did the surgery told them to "have their primary care doctor do it", etc. etc. and on and on.
There is also the aforementioned ego issue, and people's general discomfort with not knowing things (you CANNOT know everything about everything, so there will always be things you don't know as a primary care doc, whereas as a specialist you can at least have the delusion that you know everything in your field).
There is also the fact that primary docs have to see too many patients/day. On my endocrine clinic rotation in residency, the endocrine docs were seeing fewer patients than the general IM clinic would see, but only taking care of 1 or 2 problems (say, hypothyroidism and maybe, at most, one other like diabetes). In a similar visit at my IM resident clinic, I'd see an equal or greater number of patients in a half day, and take care of the same patient's anxiety, back pain, obesity, Type IIDM, HTN and then have to remember to refer them for a colonoscopy.
