Why the aversion to primary care specialties?

[babdoc]

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To add to this, I would say that we in general do a poor job training residents and students to manage expectations during clinic visits which ultimately leads to a poor opinion of primary care. It doesn't have to be stressful. And in the real world, the benchmarks often are wrapped into automatic functions of the EMR. It's not that hard to order all of the vaccines or labs that are due, for example. Those counseling benchmarks are only required once or infrequently. You don't do them all in one visit.

Addressing only a few (2-3) issues (preventative stuff/screening, what the doc wants to to accomplish (adjust chronic management), and what the patient wants addressed (this new pain, etc.) in an office visit is reasonable. Then explain that you need to bring them back to address other things further. That is very different from what we do in the hospital where our H&P covers essentially all problems at once. It is a skill to triage the important issues (e.g. new chest pain) and put off less concerning things (stubbed toe).

Primary care, IMO, is made or broken on work flow. I see a lot of residents that shirk it before they figure out that work flow. And students that do rotations with residents see that. I say that was the benefit of doing my primary care rotations one-on-one with docs in the community. I got to see PCPs that have figured out the work flow and can get things done efficiently without getting weighed down.

I think it pretty much depends on what is stressful to you as an individual. I've worked with PCPs who were stressed in all the ways you just mentioned, but worked 45-50 hours a week with no nights, no call and few weekends. One in particular was able to get his charting done during the day, so when he went home, he was done. On the other hand, I've seen specialists who work 12 or 14 hours a day AND almost every weekend (the latter made a fortune, I'm sure.) So like everything else it goes back to what you like and what you want.

 

[hallowmann]

To add to this, I would say that we in general do a poor job training residents and students to manage expectations during clinic visits which ultimately leads to a poor opinion of primary care. It doesn't have to be stressful. And in the real world, the benchmarks often are wrapped into automatic functions of the EMR. It's not that hard to order all of the vaccines or labs that are due, for example. Those counseling benchmarks are only required once or infrequently. You don't do them all in one visit.

Addressing only a few (2-3) issues (preventative stuff/screening, what the doc wants to to accomplish (adjust chronic management), and what the patient wants addressed (this new pain, etc.) in an office visit is reasonable. Then explain that you need to bring them back to address other things further. That is very different from what we do in the hospital where our H&P covers essentially all problems at once. It is a skill to triage the important issues (e.g. new chest pain) and put off less concerning things (stubbed toe).

Primary care, IMO, is made or broken on work flow. I see a lot of residents that shirk it before they figure out that work flow. And students that do rotations with residents see that. I say that was the benefit of doing my primary care rotations one-on-one with docs in the community. I got to see PCPs that have figured out the work flow and can get things done efficiently without getting weighed down.

My very first rotation of 3rd year was an experience at a program with a good EMR, and better PD and attendings. They repeatedly emphasized the importance of prioritizing and choosing a clearly limited number of problems to address. They also had incredible relationships with their patients. Needless to say it had a big impact on me, and even though I've rotated through some incredible and terrible specialties (and even a terrible FM) this year, I think back to what that PD and those attendings taught me.

As other people have said, do what you love most. As much as I like many other fields to some degree (and honestly could picture myself being successful in most of them), being an FM (or even PC IM) doc is the job I can picture actually being happy to go to everyday, the type of job I picture myself growing old in. That's really what you have to figure out. And if you don't find something like that, pick the highest paying one with most vacation time 😛.

 

[group_theory]

There is an article in The DO that talks about physician burnout in family medicine. Apparently a survey by Medscape showed more than half of family medicine physicians are burnt out.

The comment section in the article is also interesting

http://thedo.osteopathic.org/2016/0...hysicians-are-burned-out-according-to-survey/

 

[IslandStyle808]

There is an article in The DO that talks about physician burnout in family medicine. Apparently a survey by Medscape showed more than half of family medicine physicians are burnt out.

The comment section in the article is also interesting

http://thedo.osteopathic.org/2016/0...hysicians-are-burned-out-according-to-survey/

Finding it strange that the person counseling doctors from high burnout specialties is one that specializes in a field where burnout is probably the lowest. I have to agree with the comments below, the techniques suggested by the article are ways to manage the issue and not tackle them head on. The problem lies with doctors being pushed around by administrators, insurance companies with little to no support from the AOA (not like the AMA any is better). As more doctors become employees of hospitals, there might be more of a need to for them to unionized. I was speaking to a family friend more recently (an older doc) who wanted to retire early from medicine because it has been too much about fulfilling metrics and not so much treating patients. In the end, doctors need to unite (whether by specialty or as a whole) and push back against the system in order to give doctors more autonomy.

 

[ERDOC555]

http://healthaffairs.org/blog/2015/...nt-and-pharmacist-pipelines-continued-growth/
There are roughly 3,000 and some change FP spots out there. In comparison, the number of NPs has gone up by over 100,000 in over just the last 15 years, and the number of PAs has doubled in just over a decade. There are 26,000 midlevels training at any given time now, the majority of which are mainly qualified to enter primary care. Eventually they're going to saturate the market. If you go into a high-liability or procedure-heavy specialty, you're much safer, as midlevels are far less likely to take these positions for medicolegal and scope of practice reasons. I'm looking at being an IM specialist in a field with procedures that cannot be performed by a midlevel (or even other physicians) and be reimbursed, because screw losing my job to some hack that never made it through medical school 20 years down the line.

Hi Mad Jack!

I've seen your posts quite frequently around here and I tend to agree with and have a lot of respect for the things you say.

If you don't mind me asking, what IM sub-specialty are you looking into? If you don't want to post it here please feel free to message me. I'd also be curious to know what other (non-surgical) specialties may be insulated from future threats!

Thanks in advance!

 

[hallowmann]

There is an article in The DO that talks about physician burnout in family medicine. Apparently a survey by Medscape showed more than half of family medicine physicians are burnt out.

The comment section in the article is also interesting

http://thedo.osteopathic.org/2016/0...hysicians-are-burned-out-according-to-survey/

Seems like 50% or more of physicians in general are burnt out. The low burnout specialties are in the low 40s (Psych, Derm, Endo, Pulm, Ophtho), but most are reporting 45-55% burnout.

 

[Azete]

I graduated law school and worked in finance, so I laugh when I read threads about stress and the future of medicine. Imagine having comparable debt and a roughly 50% chance of never being lucky enough to work more hours for lower pay after graduating, with job security entirely dependent on a stable economy.

The burnout rates are not exclusive to medicine, these are shared by basically every profession out there.

 

[JustPlainBill]

I graduated law school and worked in finance, so I laugh when I read threads about stress and the future of medicine. Imagine having comparable debt and a roughly 50% chance of never being lucky enough to work more hours for lower pay after graduating, with job security entirely dependent on a stable economy.

The burnout rates are not exclusive to medicine, these are shared by basically every profession out there.

Right?! -- Burnout -- yeah, it probably happens -- but think about this -- imagine working 2 part time jobs during the week for $7.50/hr and cleaning an office for 2 hours on the weekend for an additional $150/month -- and you don't have a sitter since your children stay with grandparents during the week while you're struggling to make it so they get to go with you while you clean the office and sit there for 2 hours --- try doing that for 2 years -- oh, and do that while you're taking pre-med prereqs AND studying for the MCAT trying desperately to get into medical school or your children will become very familiar with the phrase, "Attention Wal-Mart Shoppers" ---

I am intimately familiar with the above paragraph since it was my life --- and now, every time I am sitting at the kitchen table at home doing charts, I think about how much more I'm making and how God changed the course of my family in less than 12 years ---

Burnout -- it happens -- but it happens a lot less when you're grateful for what you have and have looked over the abyss into the alternatives -- do I whine/gripe a lot and get frustrated at work and with patient's --- sure, comes with the territory.

But my worst day as a physician is better than any previous position I've held.....

and so it goes ---

 

[Jinxapotato]

Also I want to point out that "burnout" is more of a subjective measure than objective measure. One person's "burnout" may be when he found out that his coffee machine doesn't work, while another may be contemplating suicide. The psychiatrist may feel burned out after seeing 10 patients while the surgeon might feel burned out after doing 10 surgeries, the amount of stress you sustain tho, is not comparable.

 

[SurgeDO]

i think all of you should go into primary care.

 

[JustPlainBill]

i think all of you should go into primary care.

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