Wednesday, April 04, 2007

Students: The future is in primary care

An anonymous student asks:

I'm a third year medical student in Charleston, WV. I'm having a tough time deciding what to be when I grow up. "Do what you love." Is the most common comment I get. This is a problem for me because so far I've loved everything. When I started medical school I was set on family medicine or general internal medicine. I still think I'd be happy with either of these options. However, sometimes I feel it might be a mistake for me not to specialize so I will have a more valuable skill when I finish. . . .

I have a small family (wife, one daughter) and plenty of loans. I feel a little discouraged by the reimbursement disparity between general practice and specialty practice. Do you think this pay gap will get even wider? What do you see as the future of primary care medicine in America?

I am a contrarian on this issue, but I believe that the professional satisfaction that can come from being a primary care doctor will come to be enabled by an increase in salaries and better working conditions for those professionals. Here's why. As payors in the health care system face more and more financial pressure (either from employers or government legislators), they will seek to maximize the value of dollars being spent. PCPs are uniquely situated to deliver the goods for them.

Today, PCPs are dramatically undervalued and underpaid, relative to specialists. Fewer and fewer people are becoming PCPs. Yet, they remain the most trusted source of information for patients. (See, for example, page 12 of the recent Blue Cross Blue Shield survey on how consumers make health care decisions in Massachusetts.) Besides being trusted, PCPs are the gateway to the health care system, and they are needed to determine the most efficacious diagnostic and treatment paths for patients.

The current rub is that PCPs get to spend 18 to 20 minutes with each patient because the fee they are paid for visits is so low that they have to see many patients each day to make a living. There is no way they can do a really complete job, much less focus on prevention and wellness. In contrast, we see the assertions of doctors in so-called concierge practices who have more time to spend with the patient, asking personal and family-related questions, doing more physical diagnoses, and focusing on prevention and wellness. They claim they can actually reduce the downstream costs of specialty and hospital care.

Now, you might rightfully say. Prove this with a case-control experiment. I will not try. I will simply assert that common sense suggests that if PCPs are given more time to spend with patients, they will be able to do a more thorough job at prevention and diagnosis, with obvious downstream benefits. If you are Medicare, Medicaid, Blue Cross, or any other payor under pressure from those who send you money, sooner or later you will skew your reimbursement system to enhance this segment of the medical profession and encourage more, rather than fewer doctors, to become PCPs. You might, by the way, tie those salary increases to improvement in quality metrics. This recently happened in the United Kingdom.

Assuming I am right, our Mountaineer friend still has a dilemma. How long will it take for this transition to take place, and will he starve in the meantime? I do not know, but I am guessing that he will see the shift begin by the time he finishes residency training and accelerating thereafter. So, my advice is "Do what you love." Marcus Welby, MD would be proud of you.

39 comments:

Doctor David said...

Right on the money!

Anonymous said...

While my heart is with Paul, my head says "no" - for three reasons. First, Medicare physician payment policy drives all other payment policy. If Medicare steps up and pays more for primary care, everyone else will, too. The reverse is also true. For the better part of thirty years, Medicare has paid more - a lot more - for specialty care than it has for primary care. Unless and until Medicare changes its tune, the specialists will continue to get paid more - and there will be more specialists. Second, we live, unfortunately, in an age of specialization. Everyone wants to see a "specialist" - no matter how mundane their own illness/malady might be. As the Baby Boomers age into their 60s and 70s, they will demand specialty care - because that's just the way they are. Third, the culture of medical school generally and academic medicine in particular - driven in part, I'm sure - by NIH funding, which also tends to reward specialists - glorifies the specialist at the expense of the general practitioner. This creates a pro-specialist atmosphere in most medical schools that will be hard for students to resist.

SO - while I agree with virtually everything Paul said about why we should see more primary care in the future, I have grave doubts about the likelihood that his vision will come to pass.

mark said...

I agree with Paul. But the forces restraining this adjustment are strong. So, unfortunately, I also agree that we can’t predict when these adjustments will occur.

avid reader said...

Small request for those of us not in the field. Can you please write out the acronyms the first time you use them? Call me stupid but PCP took me a bit? Isn't that a street drug? And, for the electronic record, I love my PCP (the person, that is).

djs60 said...

It's a pretty discouraging situation (I am a primary care doc). If a student has a large debt burden, it's really difficult for he/she to do primary care - the pay just isn't high enough. The federal government could certainly do more in terms of loan repayment/forgiveness programs than it now is doing to help with the imminent primary care crisis (I think things will get really bad in the next 10 years).

Medicare needs to completely start over in terms of how they set payments for MDs. The current system is hopeless in terms of fairness to primary care docs. There was an excellent review of this issue in a recent issue of Annals of Internal Medicine:

http://www.annals.org/cgi/content/full/146/4/301

Ileana said...

I'm with Paul, do what you want to do!

But think out of the box. It is the youth that will change the system. Know the limitations and try to find solutions to them before you get entrenched!

It is people that say and think that the system is unbeatable that make the system unbeatable.

Trust that change will happen and it will happen soon.

When I was 17 in communist Romania, it looked like computer science was nowhere in anyone's future. A college teacher told me to go with my heart because things will change. I am grateful forever for taking his advice. Even before I was out of college my world changed and computers were right there.

Anonymous said...

The GP is, along with the ER specialists, at the front lines of medicine. They may be considered gatekeepers into the higher-cost of specialists and, as such, are great assets to the insurance carriers who would rather not have patients with hangnails visiting podiatrists. By virtue of this, and their considerable practical experience, they most certainly deserve an equitable piece of the pie. Maybe they should unionize?

My own doc came into the profession first as an electrical engineer and has managed to survive well by combining interests into related ventures. But the picture is not so great for others who must dispense medical care in the manner of an assembly line in order to keep the lights on.

Good government takes care of the people and encourages those who help in the process. Government that takes the lead in providing affordable and quality health (and other) care is one that lives up to the reason for their existence.

Since the mid 60's I've seen (US) government go through ups and downs in this regard, but never has it dropped to such a horrific low where an appropriate seal would be a raised middle digit.

You don't do that to your caregivers and get away with it for too long.

Paul Levy said...

Sorry avid reader. I can't believe I have learned enough to use acronyms! I guess i am no longer a neophyte. Egad, I fear now I will have lost all objectivity . . .

BC said...

I have two questions and two comments. My questions are: (1) if PCP reimbursements were raised enough to allow them to spend an adequate amount of time with patients to do the job they think needs to be done, and, at the same time, we pass insurance reform to cover the 47 million currently uninsured, where will the supply of PCP's come from to take care of everyone? (2) Conversely, if retail store clinics staffed by NP's continue to proliferate, even though they only offer a very limited range of services, how significant an impact would there be on the demand for PCP's?

My comments are: (1) In theory, the pricing of PCP services lends itself especially well to time based billing. If there is test equipment in the office that the doctor also uses for EKG's, sonograms, stress tests, X-Rays, etc., perhaps the hourly rate charged for all visits could include an adequate amount to provide a satisfactory return on the investment in the equipment. This could remove the incentive for excessive testing to drive revenue. (2) If Medicare and Medicaid wants to experiment with considerably higher compensation for primary care doctors, an ideal place to start would be supervisory care for long term care residents in nursing homes. There are a lot of services (like physical therapy) provided that are done more to drive revenue for the nursing home than benefit the patient. With adequate supervision from primary care doctors, much of this could be eliminated.

David said...

This is just a brief comment on the following quote from the first anonymous commenter:

"Everyone wants to see a "specialist" - no matter how mundane their own illness/malady might be. As the Baby Boomers age into their 60s and 70s, they will demand specialty care - because that's just the way they are."

As a "Baby Boomer," I take exception to this sweeping generalization of my generation. Not "everyone wants to see a "specialist" - no matter how mundane their own illness/malady might be." With regard to medical care, I'd rather see my PCP any day because he embodies the qualities of an excellent physician. He always actively listens and only prescribes additional treatment, (including referral to a specialist), if it is truly necessary. As for the comment, "that's just the way they are," I can't help but wonder which generation this commenter is a part of. Blanket judgements like that are inappropriate at best.

My generation and the generations to follow are going to continue to need top flight PCPs. That said, I would encourage the budding physician to be mindful and steadfast with regard to choosing his path rather than succumb to pressures with other than his, (and his patients'), best interests at heart.

Dr Scott said...

Paul, your post is very good, but brought down by three words:
"Common sense suggests..."

The current health care delivery environment has nothing to do with what is "right" or "good." It is dictated by accountants, legislators, and MBAs--not MDs. Primary care is not flashy, it doesn't (directly) benefit those with loud and powerful lobbies, it doesn't make exciting headlines. On the Medicaid/Medicare side, our government has repeatedly shown that long-term thinking is not its strength. On the private payor side, the value to shareholders is all that matters. Managed care organizations have no problem squeezing every dollar out of primary care as long as they can get away with it.

The decline of primary care will continue until we reach a crisis, and then it will continue a little more. Yes, primary care will survive, but not with small community-doc practices. At the risk of prognosticating, I believe we will see more NPs and PAs, more "minute clinics," and the remaining true MDs going into larger and larger mega-groups as their only viable practice option. Primary care providers can look forward to continued stagnating reimbursements and continued loss of autonomy. I believe our anonymous student has every reason to be concerned about his ability to support his family in the future; while I agree that "do what you love" is of prime importance, he must realize that a PCP should set his sights on a solidly middle-class employed lifestyle, and not the upper-class domain of our specialist peers.

Anonymous said...

Sorry I'm behind...this is in response to your 3-22 post. I am a MD that previously worked as an RN, on the night shift While I will agree that "days" generally had the experience, there are also experienced nurses that choose work night shift. Night shift RN's don't usually have fully awake MD's or even MD's in house to deal with situations that arise regardless of time of day. Plus the MD's don't want to get out of bed to evaluate the patient, get irrate with repeated phone calls and when they finally come see the patient, it's almost too late. Don't blame night shift. They lose years off their life (documented) and screw up their normal body cycles to care for patients and continue to keep hospitals working. Show some respect.

A former night shift RN turned MD
JC

Ray said...

As a primary care provider (pediatrician), I would be happy to have 18-20 minutes to spend on each of my patients. Usually, it's closer to 12-15minutes- and that includes being updated on school, home life, developmental issues, anticipatory guidance, etc. And then there's typically hidden work to be done- school forms, returning phone calls, coordinating care, refilling prescriptions.
With low (relative to costs of training and opportunities in other fields) reimbursement and increasing competition from NP's, PA's, and drugstore clinics, we must ask itself whether it really makes sense for physicians to provide basic primary care.
In addition, I wanted to provide a link to an excellent article written by Dr Bodenheimer about the determination of Medicare reimbursement, with respect to PCP's and specialists. It's great insight into what is usually a black box.
http://www.annals.org/cgi/content/full/146/4/301 It is a perspectives column published in the Feb 20, 2007 issue of Annals in Internal Medicine.

Paul, please keep up the good work with the blog- I'm quite interested in moving into hospital administration (am earning my MBA) and appreciate your insights and perspectives.

Carol said...

Another baby boomer here (albeit a 1964 one so I'm not always sure which class I get shoved into). My PCP is the best thing that ever happened to my health. Occasionally he pulls out his orange referral sheet and I always say, "Oh c'mon you can do this. Don't send me to a specialist!" I even said this when I needed surgery to remove hardware from my tibia (obviously, I got referred). I TRUST my PCP. He knows me and my maladies. He cares about my ills and my wells on a personal level. I saw him yesterday. I wasn't thrilled about a new medication. He said, "Carol, I want you to feel better", emphasis on the "I". I don't even go to a gyn for my annual. PCP - one stop shopping with a heart.

More than dreams said...

It is interesting to see the full spectrum of opposing views on this topic.

djs60 mentioned that the government should do more to address the big debt students graduate with these days and that PCPs would otherwise have a difficult time paying it back. How about addressing the question of why medical education has to be so expensive in the first place? 40K?

Anonymous said...

Have you considered a career as a hospitalist? You can still utilize your generalist training yet expand your knowledge by working with more acute patients. The hospitalist marketplace is quickly growing, with many more openings than there are qualified hospitalists. Because of this descrepency, many hospitalists can negotiate favorable compensation as well as flexible work hours.

DDx:dx said...

Contrarian, he says. Means looks opposite, thinks different he does. So what does that mean about the way things will REALLY go...Admits he sees things different.
Well, I did too. I bet my career in the early 80's that Family Medicine was the answer. Well trained, globally aware docs could right this listing health care barge....Improve outcomes AND save money, So Much Waste! Well, here I am, 17 years of practice and burned out, burned up.
I love helping patients. I just got tired of being part of the problem.
http://poemd.blogspot.com/2007/02/terrorist-in-white-coat.html

Anonymous said...

predict that primary care will be obtained from NP/PA's and web MD, unless there is a major "cultural shift" societally!

Harold said...

In my 40 year career, I have been academic specialist, nephrologist, primary care physician, and towards the twilight of my career, a "concierge" physician. The much maligned term and concept of the elitism in medicine has gathered more attention than its numbers warrant. I think the reason for the attention is that it indeed addresses the short fall in primary care reimbursement. Our company, MDVIP, now serves 50,000 patients in 18 states, and our data suggests we are cheaper and better in the practice of medicine than one would expect. HEDIS scores, hospital length of stay and frequency of admission, are all dramatically different than comparable physicians within individual states.

What is interesting to me is that we were not incented to shorten length of stay, fill in all the blanks of the HEDIS scores, etc. Our take-home message is that good medicine, practiced by trusting patients and physicians, is cheaper!

The fundamental problem with American medicine is not the lack of money, since we spend twice as much per person than any other country. Our incentives are just in the wrong place. It is easier to get an MRI than a visit with a PCP in Massachusetts.

I suspect that our role is to demonstrate what incentives drive decision making by PCPs, and realign those incentives to put PCP back in charge of patient decision-making. If I were to the young doctor from West Virginia, I would look 5 years ahead, and go into primary care. Planners will eventually recognize the enhanced value of the PCP in controlling health care utilization and costs.

Rob said...

Let's buck "conventional wisdom" of the last 30 years and try - yes, just once, actually try - to INCREASE the value of a service, rather than cutting its cost by EXTRACTING its value.

This kind of cost-cutting never out runs the attendant loss of value because why? Yes, class, because people want to do a BETTER job, not a worse one. Making them do a poor job makes them less effective, promotes cynicism and, yeah, eventually no one wants to do it.

lew said...

I agree with the advice to do what you love - the same I am giving both of my children (one of whom is entering the one field which is economically more challenging than even primary care).

I am not, however, as convinced that a fundamental change in the reimbursement structure will occur anytime soon. There is also the basic disconnect in our society (at least in regions like the Northeast), where patients demand access to all specialists as they wish and are not necessarily willing to limit themselves based on the advice of a PCP. I think, in addition, the contention that the concierge practices reduce overall cost has yet to be proven.

Some people predict the model could evolve to more primary care being done by medical specialists themselves. We will see.

Elliott said...

I think any decision about whether to specialize based on economics alone is futile given the enormous uncertainty moving forward. It is highly likely that the US will finally go to some form of universal access in the next 15 years in which time (given that this question was from an anonymous medical student) things will change radically only a few years into his or her career. If you were just doing it for the money then you might have chosen the wrong field entirely. A more lucrative choice would probably be to become an energy efficiency expert.

Anonymous said...

My advice as retired M.D. is to straddle the fence - get board certified as an internist, thus keeping your flexibility (easier to go on specialist training or retrain if necessary, or be a hospitalist as someone suggested). Then see where the profession is going once you get there, to determine what you want to do. I believe there is a 50:50 chance that the outside pressures Paul cites will have drastically changed medicine by the time you finish your training - or else everyone will be on salary so it won't matter...

Toni Brayer MD said...

Even if "Student" follows his passion and chooses primary care, few of his fellow residents are following and the primary care crisis is upon us.
Fewer than 19% of Internal Medicine Residents are choosing primary care as a career.
General Internists have lost 10.2% income to inflation and the largest health payor - Medicare/Medical has disadvantaged primary care for years.
The unintended consequence of having essentially NO national health care policy, is that primary care specialties (pediatrics, family practice, internal medicine) will continue to decline. This will be a disaster with increase costs and declining quality. (contact me if you want references. I have many)

It is heartwarming to see the love patients have for their PCP (primary care physician) but love and good wishes alone are not enough. I have practiced primary care medicine for 24 years. I have loved medicine, but would not recommend it as a specialty choice unless our government makes healthcare reform a national priority.

(almost) dr. jess said...

as someone who just matched into a primary care residency track, i can totally sympathize with what this student is facing.

i love primary care, but i have heard many, many reasons why i shouldn't.

1. i'll burn out because i have to see so many patients a day just to break even.
2. nurse practitioners and physician assistants are cheaper and will take over the field.
3. i'll get bored because i won't use my brain.
4. patients will want to see specialists for their problems, not generalists.

however, when i talk to primary care doctors, they seem to be a very happy bunch, and i think it's because they like what they do. yes, reimbursements are tough, but they love their patients and the services they can provide. i believe i would also love being a PCP, and i hope to find a practice environment that will allow me to continue enjoying practicing general medicine for a good long time.

however, it's not easy being someone interested in primary care. there's a lot of criticism out there. in the august 31, 2006 edition of NEJM, there are two perspective pieces on primary care. one is called "primary care: will it survive?" and the other is "becoming a physician: primary care--the best job in medicine?"

so, there are a lot of opinions out there. i'm still keeping an open mind towards specializing, but i can see myself being happy as a PCP. i like to think that the practice environment will get better as the people are recognizing the great shortage of PCPs out there, but we'll see what happens.

Labor Nurse said...

I agree that our health care system in general is in need of major overhaul, but I just can't wrap my head around the horrible income primary care physicians have to deal with. Perhaps I need some actual numbers to see how difficult it is for a physician to go into primary care. Is the (I'm guessing) $100K income not enough to survive on? I understand that there are school loans, mortgages, and the like to be paid, but I am sure that this income can cover those expenses.

And with the NP's and PA's that are "taking over", are they getting reimbursed by Medicare/Medicaid at the same rate as the MD, or are their reimbursement fees less? I quote that "taking over" because they need physicians to practice.

I'm with those who support this student's desire to go into primary care. There has never been a better time to get into a field that needs passionate practitioners.

Joe Wright said...

I've commented at more length on this discussion at my own blog:
http://hemodynamics.blogspot.com/2007/04/current-crisis.html

The summary is, although there are a lot of things wrong with primary care, whether there is a crisis in primary care or simply the same old chronic problems is unclear.

One clear example is visit time. During a period (late 1980s-late 1990s) when many people were asserting that managed care was destroying the relationship of physician and patient by compressing visits, visit time didn't change, and physician income increased relative to inflation (except in ob/gyn, where it declined 6%).

It is often convenient to assert a historical crisis in order to generate a sense of urgency; in my view, the urgency is that we shouldn't live with the problems of our system. But problems are probably not new.

From this I also conclude, do what you love.

Anonymous said...

to address "labor nurses" question, the average salary for a primary care MD in the US is about 150K (although some docs make a lot less). The average educational debt of a US med school graduate last year was 130K. If paying back at 7% interest, this would require 20 years of monthly payments of $1000. Also to be considered is the opportunity cost of medical school & residency training (residents at the hospital I work at are paid about 50K). If you were to go straight though college -> med school -> residency -> "real job", you will be near 30 before you get a good sized paycheck (and your debt will have risen if you deferred payments while a resident).

So, primary care doctors are pretty well paid by comparison to the US population as a whole, but not relative to radiologists (250K), or Paul Levy (1,000K), or Manny Ramirez (18,000K).

The other unfortunate fact for primary care doctors is that their pay has not kept pace with inflation - pay in real dollars in 2007 is considerably less than it was 10 years ago.

In the area I live (Boston), a primary care doctor with an average salary and an average educational debt would have difficulty affording an average house in a community with good schools. And then there's the issue of putting kids through college.

One other comment about the NPs & PAs taking over primary care; salaries for NPs and PAs are not all that much lower than MDs. In the Boston market, an experienced NP can make 120K. Because reimbursement is higher for services provided by an MD, and because it tends to be true that you can get more work out of an MD (inpatient care, call, work that's too complex for an NP or PA) they are a better buy if you are running a practice.

Anonymous said...

To the student Mountaineer,

As well spoken by several before me, do what you love. I've been a family doctor now for about 4 years, and am just beginning to reap the benefits of getting to know my patients and their families. The look of relief on a worried face at just seeing me come into the room (not because I'm all that brilliant, but I care and I listen) is truly inspiring, and makes the next three prior authorization forms tolerable. Maybe I'm just not burnt out yet, but I really love what I do.

All that said, I had $180,000 of loans to pay off when I started working. My advice? Find a Federally Qualified Health Center near where you want to work, and let the government (state or federal) pay off your loans. I don't make what I would in private practice, but my loans will be GONE in another 3 years. It's been a great choice for me, and it's a place where people really need your help.

If I had to do lap chole after lap chole all day long I'd die. You'll never be bored in family medicine.

Labor Nurse said...

Anonymous @ 6:28pm, thanks for the numbers. So if the average primary care doc in the Boston area makes an average of $150K a year, and (I'm estimated average figures here) they have approx $1000 in student loan per month, and a mortgage of about $2500-$3000, this leaves $12K per month for other expenses. I'd imagine utilities around $700, car payment about $350 (but I drive a Subaru so maybe I am way off on that one), credit card approx $1000, and this leaves $9950. Of course, I am not accounting for taxes and groceries, etc but do people spend that much on miscellaneous things? Do you pay for malpractice insurance out of pocket? I'm trying to get what eats up the entire income per month. I'm certainly not saying it isn't possible, but seeing that my household income is much less and somehow we do ok. Oh, and I am not including that most will have a spouse with a second income. Thanks to those who can help clarify!

Toni Brayer MD said...

Labor Nurse, I am not following your math. Also, you left off taxes.

Paul Levy said...

Right. Start with salary (net of medical malpractice premiums), and first subtract federal and state taxes. Then mortage and local taxes or rent, and utilities. Then subtract repayment of medical student loans:

According to this site, http://www.urmc.rochester.edu/smd/about/newsletterArchive/newsletter09292005.cfm,

"In 2003, median educational indebtedness for U. S. medical school graduates was $100,000 for public and $130,000 for private medical schools, according to an AAMC report released in March, 2005. If tuition increases continue at this trend, these figures for public and private medical schools are projected to be $120,000 and $160,000, respectively, for the Class of 2007."

But, I am not saying PCPs will live in poverty. I am just saying that their salaries, relative to many other specialties, will be lower. BTW, the same is true for pediatricians. This causes many students to pick other types of medicine. This is a shame, given their value to patients and the overall health care system.

Labor Nurse said...

I realize I left out taxes, I said this in my previous post. I was making estimates. Anyhow, I guess what I wasn't understanding was the underlying notion that primary care MD's (as well as peds and family med) were poor. And being one of the regular folk making regular folk pay, I'd take their income AND their bills any day.

Paul Levy said...

Fair enough! Thanks, as always, for your thoughtful comments.

Bob Coffield said...

Thanks for discussing the important role primary care plays which leads to better preventative care. IN my opinion good primary care services play a critical role in the improving our current health care system. Incentives have to be created to move the system in this direction. I enjoy all the comments and discussion.

As a fellow West Virginian and health blogger I thought I add my own follow up post and include a link to a recent post by Dr. Charles on "mircro practices." If the anonymous WV med student is reading -- I'd love to talk more on the topic (if you are in the Charleston area tI'll meet you down on Capitol Street for coffee and a chat).

Anonymous said...

A major insurance company here in a major city (one of the largest in the country) pays $17 (that includes a $10 copay from the patient) per 15 minute well-visit. So if you see 4 patients in an hour and they all have the same type of insurance, you have just made $68.

With that $68, you will have to pay the staff (billing staff, medical assistant or nursing), rent or mortgage of the medical practice, any related business insurance, utilities, and then with what is left over, is your income (which from that, you have to pay malpractice insurance, student loans, etc).

This picture is wrong on 2 front ... first, the patient is paying a $100-$200 monthly premium for his insurance ($10 copay, no Rx coverage) ... and the practice is only getting $17 total for the visit (the insurance pays $7).

With such market conditions, a lot of primary care offices are no longer taking this insurance, and a lot are no longer taking Medicaid and Medicare patients (not because PCPs are cold-blooded but economic realities dictate that you can't operate a private business if you can't break even)

And it is also against the law for individual physician practices to gather together to negotiate with insurance companies (so in reality it's more "this is what we are willing to pay, take it or leave it" from the insurance companies). (i believe physicians can't get together to negotiate because of Anti-Trust laws but you will have to ask a lawyer for specifics)

Oh ... California and CT are considering taxing 4% of physician revenue to pay for universal healthcare (CT recently drop the proposal)

In this economical and political environment, what is the incentive for a Class of 2007 graduating student, with a $160k loan (more if there are undergrad loans), about to spend the next 3-4 years working 80hrs/week making $38-$50k/year ... to go into Primary Care (and deal with low reimbursement, lots of paperwork, pre-authorizations, a risky legal environment, multiple phone calls at night)

There is no doubt with baby boomers retiring, we need primary care physicians. But like everything else in life, there must be incentives for people to go into the field. Where are the incentives to go into this field?

Anonymous said...

To Labor nurse;
I bet you work regular folk hours and received regular folk training, too. Please don't underestimate that factor. Also, most docs don't start earning even a regular folk income till later in life than regular folk. If you converted all that into a $/hour lifetime income, it might be much lower than you think compared to yours.

Anonymous said...

Labor Nurse,
I agree with anon 9:16. I finished residency before the 80 hr/week limit. It was not uncommon for us while " in training" to work 100 plus hrs per week prior to this rule. I even worked a 36 hr day as an intern (WITHOUT SLEEP) and had to be back at 7:00 am the next day. I am a Hospitalist and only work about 55 hours /week now and make about $200,000/yr. Do I think I earn my money? You bet I do. If you would like to become a primary care doc and earn $150,000/yr, have at it, take the MCAT's, apply and do your time and then see how you feel about the " great wage".

Anonymous said...

Well, after going through the entire argument with both sides explaining very well, the dilemma still is 'to be or not to be' a PCP that is...well I am a PCP and have recently started working but so far i feel each of us should do what we love to do, because at the end of the day the question is, are you happy?, if you do it for anything else like money who knows whats enough, we tend to spend whatever it is, really i was earning by the hour in college days and residency with barely enough and still was as happy as i am now....
so do what u love to do...and leave the rest..it will sort out..