Would you go into primary care if....

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GypsyHummus

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It is well known that there is a maldistribution of doctors in america: the ratio is off, there are too many specialists to primary care physicians PCP. How can the country stop the PCP shortage?

The only permanent solution that I can think of that would have lasting effects would be to artificially inflate the reimbursements of PCP or cut specialties across the board to make it less attractive than PCP.

Would you be a PCP if all your student loans were forgiven? Like from undergrad and med school? completely paid for?

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It is well known that there is a maldistribution of doctors in america: the ratio is off, there are too many specialists to primary care physicians PCP. How can the country stop the PCP shortage?

The only permanent solution that I can think of that would have lasting effects would be to artificially inflate the reimbursements of PCP or cut specialties across the board to make it less attractive than PCP.

Would you be a PCP if all your student loans were forgiven? Like from undergrad and med school? completely paid for?

This thread is premised on two false assumptions.

1. Everyone doesn't want to do primary care.
2. The reason everyone doesn't want to do primary care is the relatively low salary.

If at the end of M3 I dislike primary care, no inflated income or lone forgiveness would make it worthwhile. Being unhappy in my profession is not something I would volunteer for.
 
This thread is premised on two false assumptions.

1. Everyone doesn't want to do primary care.
2. The reason everyone doesn't want to do primary care is the relatively low salary.

If at the end of M3 I dislike primary care, no inflated income or lone forgiveness would make it worthwhile. Being unhappy in my profession is not something I would volunteer for.

What if the opposite is true? You love primary care, but it just isnt financially feasible?
 
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Med school is tough to get into. Lots of med students are Type A personalities. We shouldn't act so surprised when classes are full of Type A personalities and they are going after what is perceived as the "top".

Loan repayment programs do exist. They have recently been expanded to my knowledge. It's not like PCPs are getting paid pennies on the dollar... If people really have serious issues the military has good loan repayment programs.
 
Honestly, I don't know. I would do whatever I feel would make me happy as a practicing physician. Many med students and residents around here have said that the majority of people change their mind about what kind of medicine they want to practice once they learn what is all about. Us premeds don't know what certain specialties entail.... but I digress. If I made it into med school I will do my best to find the field that will suit me best regardless of compensation.
 
Primary care seems a bit boring. (I have no experience in it though)
 
Primary care seems a bit boring. (I have no experience in it though)

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I think people are driven less by money as we think. Like other posters have mentioned, there are loan repayment options available, many of them quite generous if you can put up with some extra stuff for a few years (military, national health service). Many doctors (specialists too) can make significantly more money working in an underserved area, but they choose not to.

The problem with primary care isn't completely numerical. There are distribution issues too. You have a very high primary care physician population in "more desireable" areas even though people can make more money/get loans repaid if they chose to work elsewhere. Throwing more money at the problem will help somewhat, but many people choose specialties and they choose overserved locations for reasons that go beyond money.

Maybe a better approach that many schools seem to be trying is to bring in students that will work in underserved areas. URMs do this somewhat (I don't want to debate that now), but you can also look at SES and where the student comes from. For example, my state school has a rural track. From what I've heard, it's very difficult to "fake" your way into one of these spots. If you aren't from a rural area, you have an uphill climb. If you have no experience in rural healthcare, you have no chance. Unlike expressing an interest in primary care (which can be faked or changed for legitimate reasons), this type of selection process will be higher yield. A student from a rural area is much more likely to return then a student not from there (even if this non-rural student was offered more money). Returning to a rural area will probably also make them less likely to specialize since it isn't necessary. Though, many of these areas lack specialists too, so it wouldn't be a bad thing if they did specialize too. I don't know if the program is old enough program to see how it works yet, but it seems like a much better solution to me.
 
There already are lots of programs that will forgive all or part of your med school loans if you pursue PCP or rural/underserved medicine.
 
I think people are driven less by money as we think. Like other posters have mentioned, there are loan repayment options available, many of them quite generous if you can put up with some extra stuff for a few years (military, national health service). Many doctors (specialists too) can make significantly more money working in an underserved area, but they choose not to.

The problem with primary care isn't completely numerical. There are distribution issues too. You have a very high primary care physician population in "more desireable" areas even though people can make more money/get loans repaid if they chose to work elsewhere. Throwing more money at the problem will help somewhat, but many people choose specialties and they choose overserved locations for reasons that go beyond money.

Maybe a better approach that many schools seem to be trying is to bring in students that will work in underserved areas. URMs do this somewhat (I don't want to debate that now), but you can also look at SES and where the student comes from. For example, my state school has a rural track. From what I've heard, it's very difficult to "fake" your way into one of these spots. If you aren't from a rural area, you have an uphill climb. If you have no experience in rural healthcare, you have no chance. Unlike expressing an interest in primary care (which can be faked or changed for legitimate reasons), this type of selection process will be higher yield. A student from a rural area is much more likely to return then a student not from there (even if this non-rural student was offered more money). Returning to a rural area will probably also make them less likely to specialize since it isn't necessary. Though, many of these areas lack specialists too, so it wouldn't be a bad thing if they did specialize too. I don't know if the program is old enough program to see how it works yet, but it seems like a much better solution to me.

Not sure how much you would know about these issues but you seem to have more of an insight than I do. Therefore, if one wanted to go somewhere rural would they have to do their FM residency in one of those locations? In other words, if someone does a residency in Miami will they get job offers from Wisconsin? Also, if a place like Wisconsin pays really well, do they also have loan forgiveness programs, or is it usually one or the other?

Sorry for the dumb questions but I honestly have no clue how this works.
 
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What if the opposite is true? You love primary care, but it just isnt financially feasible?

Uh... So you're saying if I love primary care would I go I to primary care if I was offered a huge salary and/or loan forgiveness? I think that's a no brainer. Who wouldn't choose to do what they love and get paid a lot to do it?

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Uh... So you're saying if I love primary care would I go I to primary care if I was offered a huge salary and/or loan forgiveness? I think that's a no brainer. Who wouldn't choose to do what they love and get paid a lot to do it?

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No, I am saying what if you love primary care, but it isnt financially feasible? There are loan repayments, but when a PCP makes 150K and an anesthesiologist makes 400K, why in the world would I go into PCP?

Edit: Especially since gas is just one more year than PCP with almost 3X the pay.
 
I was looking at this for interviews and It seems like primary care physicians/providers are closer to the insurance industry and thus less autonomous. If you are going to educate yourself to that extent, why would you want to be micromanaged?

Also, there are easier ways to make $$ than becoming a physician.
 
No, I am saying what if you love primary care, but it isnt financially feasible? There are loan repayments, but when a PCP makes 150K and an anesthesiologist makes 400K, why in the world would I go into PCP?

Edit: Especially since gas is just one more year than PCP with almost 3X the pay.

Because its your passion.


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Choosing a specialty just for the cash is an awesome route to a midlife crisis, I'd imagine.
 
No, I am saying what if you love primary care, but it isnt financially feasible? There are loan repayments, but when a PCP makes 150K and an anesthesiologist makes 400K, why in the world would I go into PCP?

Edit: Especially since gas is just one more year than PCP with almost 3X the pay.

A pcp makes 150 per year only when he/she is content with that.

You always read of the struggles of primary care on here, but never of psychiatry or rheumatology which have very comparable salaries.
 
No, I am saying what if you love primary care, but it isnt financially feasible? There are loan repayments, but when a PCP makes 150K and an anesthesiologist makes 400K, why in the world would I go into PCP?

Edit: Especially since gas is just one more year than PCP with almost 3X the pay.

I already answered this question in my original post. Going into a specialty for the money likely won't end well for you.
 
$150k is base pay which is what you can settle for. If you take things into your own hands you can make much more than that, you just don't hear about those people that much.
 
Btw at a recent interview the dean said mean internist salary is $174k

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Btw at a recent interview the dean said mean internist salary is $174k

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I know that EM got a bump in their average salary did PCP's get a bump in their salary as well?
 
I know that EM got a bump in their average salary did PCP's get a bump in their salary as well?

I guess.

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After working so hard to get into and get through med school, there's no way you should have to settle for a specialty that you don't want.
Who cares about debt? By that point you've been in debt for about +/- 10 years.
Just do what you enjoy and it'll all work out.
 
A pcp makes 150 per year only when he/she is content with that.

You always read of the struggles of primary care on here, but never of psychiatry or rheumatology which have very comparable salaries.

I mean, I guess the sky is the limit if you own a independent practice and treat it like a small business. The problem is, that takes a lot of $$$ to get started up.
 
I mean, I guess the sky is the limit if you own a independent practice and treat it like a small business. The problem is, that takes a lot of $$$ to get started up.

So did you make this thread to make you feel better about wanting specialty just for the salary?

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No, I am saying what if you love primary care, but it isnt financially feasible? There are loan repayments, but when a PCP makes 150K and an anesthesiologist makes 400K, why in the world would I go into PCP?

Edit: Especially since gas is just one more year than PCP with almost 3X the pay.


Not counting fellowships, I think most, if not all, nonsurgical specialties have 3-5 year residencies.

And of all the specialists, why are you singling out anesthesiologists? Their job is to keep patients alive while they're being subjected to terrible bodily harm. They also routinely save the lives of patients with airways too difficult for other doctors to intubate. It only looks easy because they're so good at it.

Anesthesiology and Primary Care are two very different areas. If you don't like anesthesiology, you're going to be miserable doing it.
 
Not counting fellowships, I think most, if not all, nonsurgical specialties have 3-5 year residencies.

And of all the specialists, why are you singling out anesthesiologists? Their job is to keep patients alive while they're being subjected to terrible bodily harm. They also routinely save the lives of patients with airways too difficult for other doctors to intubate. It only looks easy because they're so good at it.

Anesthesiology and Primary Care are two very different areas. If you don't like anesthesiology, you're going to be miserable doing it.

I grew up around Anesthesiologists and specialists and they make a TON of money. I've shadowed them as well as primary care, and i just dont understand why there is such a income discrepancy. Why wouldnt someone want to make an extra 300K?
 
So did you make this thread to make you feel better about wanting specialty just for the salary?

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No, I made this thread to ask two questions:

1) what would incentivize people to go PCP since we have a PCP shortage?

2) Why dont people go PCP?
 
I grew up around Anesthesiologists and specialists and they make a TON of money. I've shadowed them as well as primary care, and i just dont understand why there is such a income discrepancy. Why wouldnt someone want to make an extra 300K?

Thought experiment:

If prostitution was legal and you could be almost guaranteed 750k for doing it. It would take about 12 years of your life to learn how to do and you would have to sacrifice a lot to get to the end. Would you do it?

The point it that it is not about the money, nor is anyone saying that they wouldn't want to make an extra 300k.

I do agree that perhaps the amount of debt that one incurs relative to the potential income could deter a group of individuals from choosing something they that really want to do, but I believe that solutions to this problem have been posted before. I also agree that by adding more loan repayment programs or making them more lucrative will entice an even larger crowd but I'm not sure if that's a band-aid or a cure.
 
No, I made this thread to ask two questions:

1) what would incentivize people to go PCP since we have a PCP shortage?

2) Why dont people go PCP?

There are more people in IM, FM, or Peds than there are other specialties. The problem isn't that people don't want to go PCP, the problem is that the need for PCP is greater than the need for other specialties.

You're under the impression that the shortage is due to supply, when in reality it's due to demand.
 

Not sure if you're being sarcastic? :laugh:

I've shadowed several different FM physicians in an outpatient setting. I see a lot of followups and medication adjustments for common diseases and disorders like diabetes, depression and anxiety, sinusitis, mild muscle and joint pain, etc. Obviously there is a lot of "behind the scenes" thinking and reasoning I'm too dumb to pick up on and understand, but it seems like many of intellectually interesting cases are sent specialists.
 
Not sure if you're being sarcastic? :laugh:

I've shadowed several different FM physicians in an outpatient setting. I see a lot of followups and medication adjustments for common diseases and disorders like diabetes, depression and anxiety, sinusitis, mild muscle and joint pain, etc. Obviously there is a lot of "behind the scenes" thinking and reasoning I'm too dumb to pick up on and understand, but it seems like many of intellectually interesting cases are sent specialists.

Pretty sure it was directed at the part about making a statement then acknowledging not having experience.
 
Primary care can make great money. It just depends on location, practice set-up and overall business acumen.

If an primary care guy has enough entrepreneurial spirit, there's no reason he couldn't bring in an annual income that equals (or surpasses) that 400k gas salary that some of you are drooling over.

He obviously wouldn't be able to make the sort of revenue to turn that kind of profit by simply seeing patients himself... so in comes the income-booster from opening clinics, satellite offices, hiring midlevels and some rookie physicians right out of residency. Likely not the set-up he'll achieve his first year out in the real world, but so it goes.

If you can manage a healthy overhead rate and run a tight ship, the pay will come.

Truth is that overwhelming majority of grads simply do not want to do this... rather, for most, it's just them seeing their own patients with maybe a nurse (or two) and a secretary.

The entrepreneur-route is obviously more complex and risky than simply taking that "150k gig at the hospital", but the pay-off is commensurate to that risk.
 
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Thought experiment:

If prostitution was legal and you could be almost guaranteed 750k for doing it. It would take about 12 years of your life to learn how to do and you would have to sacrifice a lot to get to the end. Would you do it?

The point it that it is not about the money, nor is anyone saying that they wouldn't want to make an extra 300k.

I do agree that perhaps the amount of debt that one incurs relative to the potential income could deter a group of individuals from choosing something they that really want to do, but I believe that solutions to this problem have been posted before. I also agree that by adding more loan repayment programs or making them more lucrative will entice an even larger crowd but I'm not sure if that's a band-aid or a cure.

But if by investing 1 more year into a specialty which will triple my income during my lifetime, why not?

Yes, dont go into medicine for the money, but when only one year stand between you and 300K more a year......why go PCP?
 
Not sure how much you would know about these issues but you seem to have more of an insight than I do. Therefore, if one wanted to go somewhere rural would they have to do their FM residency in one of those locations? In other words, if someone does a residency in Miami will they get job offers from Wisconsin? Also, if a place like Wisconsin pays really well, do they also have loan forgiveness programs, or is it usually one or the other?

Sorry for the dumb questions but I honestly have no clue how this works.

Once you finish residency and whereever that residency may be, I'm sure you could easily find a job in rural Wisconsin. They know that it is probably not forever (they are offering more money because they realize this). However, it's better to have a temporary doctor than no doctor at all.
 
But if by investing 1 more year into a specialty which will triple my income during my lifetime, why not?

Yes, dont go into medicine for the money, but when only one year stand between you and 300K more a year......why go PCP?

You seriously STILL don't get it? I'm sensing troll...

Why go PCP even though the baseline pay isn't 300k? Because you ENJOY primary care and that is what will make you enjoy coming to work every day. If you aren't interested in the specialties that make bank, you will be unhappy/unfulfilled for the rest of your career, but I guess you'll have $$$ to make you happy? I have zero interest in the ROAD specialties, and I am interested in EM and Peds so far. I can shadow an EM doc and I can see myself doing that and enjoying it. I can shadow a radiologist, and I'm bored out of my mind. No amount of money would change that.

At the end of the day, we'll all be doctors, and we'll all be making salaries WELL above the majority of the country. Isn't that enough? Sure a person who makes $150k to start out will be paying off loans for longer and will have a lower take-home salary than a doctor with a $300k base, but you will still be able to support yourself and a family. Personally, I'd rather do what I am passionate about and live conservatively than go into something I'm not that thrilled about just because I'll be able to afford the mansion and Mercedes sooner.
 
Re: boring

Here are two of my posts in a thread from a MONTH ago about the same ideas.

1) Continuity of care
2) Taking care of an entire family/multiple generations
3) Adults, adolescents, infants, children, OB patients
4) Office procedures: skin biopsies, joint injections, colposcopies, endometrial biopsies, IUD insertions, cosmetic procedures such as skin tag/mole removals
5) Outpatient, inpatient, combination of both

Regarding having to punt patients who are "difficult"
You don't have to punt anything unless you're uncomfortable with it.

OB: You can still manage a GDM or pre-eclamptic.
Psych: I've seen FPs prescribe combos of antipsychotics
Sports Med: You don't need to necessarily refer to ortho to do a joint injection, especially if the FP has a SM fellowship

I've seen FPs punt patients after trying one oral hypoglycemic where others have them on multiple orals and injectables.

Heck I saw FPs in Delaware doing their own colonoscopies (and getting reimbursed).
 
I would go into primary care for a Klondike bar.
 
Re: boring

Here are two of my posts in a thread from a MONTH ago about the same ideas.



Regarding having to punt patients who are "difficult"

I dislike primary care because of the "extra" things i feel they have to deal with. A lot of management can involve aspects of social well being, etc. Some people really enjoy this type of medicine. At the same time, i could understand someone with different interests than me totally welcoming this challenge. I dont believe pay to be the only reason primary care is less competitive. I do feel that for some specialties that the stress and responsibility is incomparable to primary care. Dont misconstrue my statement as belittling primary care physicians because obviously their breadth of knowledge must be huge to be able to manage a wide spectrum of disease. I just think its a little different than (just an example) than the pathologist who is responsible for making acute, final diagnoses on a cancerous mass as the patient is lying in the or.
 
...guys the average primary care doctor makes enough to support themselves and a family quite comfortably, but barring repeating residency you have to do that for the rest of your life. I dont think many people decide against primary care BECAUSE of the salary. I think it has more to do with the work itself. Some like it, some dont.

I also don't think anyone can say whether or not they like it until they have tried it. As with anything in life. There are people at the top of their class who choose to go into primary care because they like it, and there is a lot to like about it.
 
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