Monday, March 30 marked National Doctors’ Day, a day that celebrates doctors of all kinds. When most people think about their doctor, the first person that comes to mind is their primary care physician. The importance of primary care physicians cannot be understated, and they certainly deserve celebrating. After all, in the era of increasing medical knowledge, and thus increasing specialization, they are a “jack of all trades”.
Primary care physicians can manage everything from musculoskeletal injuries to psychiatric complaints. They deliver babies and provide nursing home care to the elderly. In addition to the breadth of care, they have risen to the schedule demands of 15-minute appointments per patient, while maintaining strong doctor-patient relationships.
As a senior medical student, one might assume that many of my peers and I have elected this rewarding field for our future career. On the contrary, I, and many of my classmates, will not pursue a career in primary care. This parallels career decisions made by medical students nationwide. In the 2015 match, less than half of Family Medicine’s 3,195 residency spots were filled by U.S. medical school seniors. Such numbers do not bode well for a field that is already short physicians and is expected to see a 14 percent increase in demand over 10 years.
So what is discouraging graduating medical students from this field? Unfortunately, one of the primary causes is financial. The average income of a primary care physician is approximately half of a specialist’s income. But please do not misinterpret new physicians as greedy. Medical school graduates average $190,000 in debt for private education and $168,000 for public education. At the same time we have to start repaying this debt, many new graduates are preparing to buy their first home or start a family. Never mind that we are also entering several years of a residency program where the compensation is not exactly luxurious.
Still, there is more to the problem than money. Perhaps one of the less discussed causes of the lack of interest in primary care is a fear of referral. Medical students spend four years learning about and seeing patients with interesting and rare diseases during their training at what is likely a tertiary medical center. The fear is that if a patient receives an interesting or rare diagnosis, he or she will be referred to a specialist. For instance, a patient with newly-diagnosed cancer will be sent to an oncologist. Though making the diagnosis may be intellectually stimulating, the primary care physician loses the satisfaction that comes with managing the patient.
However, it is worth noting that this belief is likely a misconception fostered by the large referral centers where we have trained. Primary care physicians only refer about 1 in 10 patients to a specialist and, even when patients are referred, Primary care physicians often continue to co-manage their patients with specialists.
What, then, can be done to fill the void of physicians in primary care? Luckily, advanced practitioners such as NPs and PAs are filling many of the gaps that exist in this field. However, for indebted medical students to enter the field, increased financial incentives and loan repayment programs are still needed. Additionally, misconceptions regarding the role of primary care in management of complex medical illnesses must be clarified. When graduating medical students realize the intellectual reward of, and are compensated appropriately for, a career in primary care, then we can expect the disparity to begin to resolve.