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Hostility Against Primary Care

October 16, 2016
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Just about every U.S. medical student who’s ever said they want to go into family medicine, or even other primary care fields, has heard this (or something like it): “Why do you want to waste your brain?”

A new study shows what we in family medicine have always known/suspected. The comments and attitudes are historic, persistent, and pervasive. In this study, the author analyzed oral primary care histories collected in the mid 1990s by Fitzhugh Mullan, which had been deposited in the National Library of Medicine. Graduation years 1935 to 1985 were covered.

Two-thirds of the interviewees reported discouragement or disparagement about primary care, and the proportion remained high for 5 decades. The culture and structure of medical education were sited as the unifying reasons for the disparagement.

This was not a conclusion of the study, but I would add as causative factors money and money. The persistent payment gap between primary care and ologist care drives medical students away from primary care. It’s not a student loan issue. Medical students are actually sharp and can look beyond a 10-year loan repayment period. Within the medical schools themselves, the total lack of primary care research funding at the federal level means family physician researchers have been set up to fail at supplying king medical school dean with the coin of the realm: NIH research dollars. Nurses, social workers, and complementary medicine advocates all have institutes devoted to funding their research interests. There is no equivalent institute of primary care, complex care, comprhensive care, multi-morbid care, or family medicine.

There is a predicted shortage of 33,000 primary care physicians by 2025. Something drastic need to happen at the medical schools to ameliorate this. With the expected gridlock in Washington predicted to continue, optimism for meaningful change is in short supply.

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6 Responses to Hostility Against Primary Care

  1. Jennae on October 16, 2016 at 10:58 pm

    The shortage will be covered by PCPs. You know, providers like MPs and PAs. They are, after all, less expensive. Money rules many decisions.

  2. Sue on October 17, 2016 at 7:06 am

    The advanced practice nurses are coming Richard…indeed, are here in growing numbers. A vacuum is readily filled – and perhaps with practitioners more able to deal with primary care over the long term.

    • RSW on October 17, 2016 at 9:55 am

      “practitioners more able to deal with primary care over the long term”

      Not sure what kind of snarky point you’re trying to make, but all the research shows that APNs are much less likely than physicians to stay in primary care “over the long term,” and, like physicians, are increasingly avoiding the field completely.

    • Richard Young MD on October 24, 2016 at 8:44 pm

      Sue,

      See my response to Jennae, if you’re interested.

      Richard

  3. Tracie Updike on October 17, 2016 at 7:31 am

    I was discouraged from going in the Family Medicine while I was in medical school. But I did it any way; I didn’t go into Family Medicine for the money I went into it for the people. 21 years later it was the right decision.

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