In case you missed this a few weeks ago, here's a well done story by Karen Brown, who followed several primary care residents and got a good sense of why many people choose not to go into this field. The story was funded by a fellowship from the Association of Healthcare Journalists and the Commonwealth Foundation. (To be clear, the quote in the title above is not mine, and certainly not my view!) Excerpts:
These young doctors are in the middle of their residency at Baystate Medical Center, a hospital affiliated with Tufts University Medical School. They’ve completed four years of medical school – so they’re already MD’s – and are now in the hands-on part of their training.
Michael Rosenblum is a residency director.
Most doctors I’ve met going into primary care talk about their sense of social justice. They want to work for underserved communities. Or to fill a critical need. It’s rare to hear people list the superficial trappings of the job as a driving factor. And that’s not surprising, Tischer says, given what they hear about the field.
But then money and prestige raise their heads:
But perhaps even more discouraging is what the money disparity says about the status and prestige of primary care.
“Here are these type A competitive people that have been at the top of their class like since kindergarten,” says Gina Luciano, who co-directs Baystate’s primary care residency. “They tried to get into the most prestigious colleges. It’s always very competitive, very competitive, very competitive.”
So when they get into residency, she says, they want to stay on the up escalator. “And you have all of these mentors that are telling you, ‘you could do cardiology, you could do critical care.’ It feels really good that here are these really prestigious things to go into in medicine. It’s hard, I think, to be swayed from that.”
Dr. Andrew Morris-Singer, who runs the advocacy group Primary Care Progress, calls this the “hidden curriculum” of medical education. And not always hidden very well.
Levitt is planning to become a hospitalist – the person who oversees basic care in a hospital. His salary will be similar to a primary care doctor, but he will have set hours, and at the end of each shift, he’ll hand over patient responsibility to the next person.
Levitt says he would consider going back to primary care if he found the kind of private practice that would make him happy, but that’s not what he saw in residency. Across the country, residents often work in urban, hospital-affiliated community clinics where health and social needs are complex, and offices often under-staffed. Since revenue often depends on the number of patients seen, there’s pressure to push them through in 15-minute increments.
These young doctors are in the middle of their residency at Baystate Medical Center, a hospital affiliated with Tufts University Medical School. They’ve completed four years of medical school – so they’re already MD’s – and are now in the hands-on part of their training.
Michael Rosenblum is a residency director.
“If you get people before medical school and even at the beginning of medical school, there’s a huge interest in primary care,” says Rosenblum. “The vast majority of medical students want to develop relationships and see patients over time. And then we see that kind of peter off.”Brown notes:
Most doctors I’ve met going into primary care talk about their sense of social justice. They want to work for underserved communities. Or to fill a critical need. It’s rare to hear people list the superficial trappings of the job as a driving factor. And that’s not surprising, Tischer says, given what they hear about the field.
But then money and prestige raise their heads:
But perhaps even more discouraging is what the money disparity says about the status and prestige of primary care.
“Here are these type A competitive people that have been at the top of their class like since kindergarten,” says Gina Luciano, who co-directs Baystate’s primary care residency. “They tried to get into the most prestigious colleges. It’s always very competitive, very competitive, very competitive.”
So when they get into residency, she says, they want to stay on the up escalator. “And you have all of these mentors that are telling you, ‘you could do cardiology, you could do critical care.’ It feels really good that here are these really prestigious things to go into in medicine. It’s hard, I think, to be swayed from that.”
Dr. Andrew Morris-Singer, who runs the advocacy group Primary Care Progress, calls this the “hidden curriculum” of medical education. And not always hidden very well.
“There’s also explicit statements like, ‘You’re too smart to be a primary care doctor.’ ‘This is a dead field.’ Or my favorite, ‘A monkey could practice primary care. Why would you do that?’” says Morris-Singer. “So it’s a whole range of things, but the basic admonition is: ‘Hey, it’s a waste of a medical education.’”Some stay true to their passion of wanting to be create deeper relationships with patients, but with a twist:
Levitt is planning to become a hospitalist – the person who oversees basic care in a hospital. His salary will be similar to a primary care doctor, but he will have set hours, and at the end of each shift, he’ll hand over patient responsibility to the next person.
Levitt says he would consider going back to primary care if he found the kind of private practice that would make him happy, but that’s not what he saw in residency. Across the country, residents often work in urban, hospital-affiliated community clinics where health and social needs are complex, and offices often under-staffed. Since revenue often depends on the number of patients seen, there’s pressure to push them through in 15-minute increments.