Blog | Wednesday, November 12, 2008

Guest blogger: My pet peeve of the day

Guest blogger Toni J. Brayer, FACP, of ACP Internist's Editorial Advisory Board, offers her comments on how the primary care shortage will doom attempts to reform health care. She writes:

Anyone who reads EverythingHealth or many other health blogs (KevinMD, Maggie Maher, Dr. Rob, Dr. Val, and Happy Hospitalist to name a few) knows that primary care physicians are a dying breed. Everyone talks about the money (painfully low reimbursement) as the cause, but equally annoying is the LACK OF RESPECT for the specialty.

Repeatedly I run across doctors who have no training in family medicine or internal medicine who say "Oh, I'll just be a primary care doctor." One doctor is an 86-year-old surgeon who was denied operating privileges so he's going to "be a primary care doctor." He did surgery training in 1948.

Another doctor hasn't ever seen a live patient. He originally trained in pathology and has done only laboratory work. He is moving to Hawaii to be a "primary care doctor."

Another has been a hospital administrator for years but wants to "see patients again" so he is going to do "primary care a half-day a week."

Give me a break! This is not a specialty you can drop in and out of as a hobby.

There is a severe lack of understanding about primary care medicine and the medical specialties of family medicine and general internal medicine. Each of these specialties requires years of residency after internship and continued medical education and exams for board certification status.

A tremendous body of knowledge is needed to be a primary care physician. One must have diagnostic acumen, know all treatment modalities, have skills in psychology, inherent common sense, knowledge of medical economics, a vast knowledge of pharmacology and hundreds of drug interactions. Primary care physicians must keep up with all of the medical literature and current evidence to be at the top of their game.

I've practiced non-stop for over 20 years and I am still challenged by patient care. Even though I could probably deliver a baby or remove an appendix or even amputate a limb if I were stranded on a desert island, I would never be so bold as to think I could drop in and out of those specialties and render good patient care.

Unfortunately the shortage of REAL primary care doctors means the field is wide open to anyone who wants to hang out a shingle and give it a try.