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.
Labels: primary care shortage
posted by Ryan DuBosar at
5:00 AM
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Members of the American College of Physicians contribute posts from their own sites to ACP Internist and ACP Hospitalist. Contributors include:
Albert
Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the
University of California, Los Angeles School of Medicine, where he
also did his internal medicine training. Certified by the American
Board of Internal Medicine, Dr. Fuchs spent three years as a
full-time faculty member at UCLA School of Medicine before opening
his private practice in Beverly Hills in 2000.
Zackary
Berger
Zackary Berger, MD, ACP Member, is a primary care
doctor and general internist in the Division of General Internal
Medicine at Johns Hopkins. His research interests include
doctor-patient communication, bioethics, and systematic reviews.
CasesBlog
Ves
Dimov, MD, ACP Member, is an allergist/immunologist and Assistant
Professor of Medicine and Pediatrics at the University of Chicago,
where he evaluates and treats both pediatric and adult patients.
David
Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally
renowned authority on nutrition, weight management, and the
prevention of chronic disease, and an internationally recognized
leader in integrative medicine and patient-centered care.
db's
Medical Rants
Robert M. Centor, MD, FACP,
contributes short essays contemplating medicine and the health care
system.
DrDialogue
Juliet
K. Mavromatis, MD, FACP, provides a conversation about health topics
for patients and health professionals.
Dr.
Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal
medicine for more than a decade and is an Associate Professor of
Medicine at an academic medical center on the East Coast. His time is
split between teaching medical students and residents, and caring for
patients.
Everything
Health
Toni Brayer, MD, FACP, blogs about the rapid
changes in science, medicine, health and healing in the 21st century.
FutureDocs
Vineet
Arora, MD, FACP, is Associate Program Director for the Internal
Medicine Residency and Assistant Dean of Scholarship & Discovery
at the Pritzker School of Medicine for the University of Chicago. Her
education and research focus is on resident duty hours, patient
handoffs, medical professionalism, and quality of hospital care. She
is also an academic hospitalist.
Glass
Hospital
John H. Schumann, MD, FACP, provides
transparency on the workings of medical practice and the complexities
of hospital care, illuminates the emotional and cognitive aspects of
caregiving and decision-making from the perspective of an active
primary care physician, and offers behind-the-scenes portraits of
hospital sanctums and the people who inhabit them.
Gut
Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist
at the University of North Carolina School of Medicine, and the
Program Director for the GI & Hepatology Fellowship Program. He
specializes in diseases of the esophagus, with a strong interest in
the diagnosis and treatment of patients who have difficult-to-manage
esophageal problems such as refractory GERD, heartburn, and chest
pain.
I'm
dok
ACP Member Mike Aref, MD, PhD, ACP Member, is an academic
hospitalist with an interest in basic and clinical science and
education, with interests in noninvasive monitoring and diagnostic
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medical informatics, new medical education modalities, pre-code/code
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Informatics
Professor
William Hersh, MD, FACP, Professor and Chair,
Department of Medical Informatics & Clinical Epidemiology, Oregon
Health & Science University, posts his thoughts on various topics
related to biomedical and health informatics.
Just
Oncology
Richard Just, MD, ACP Member, has 36 years in
clinical practice of hematology and medical oncology. His blog is a
joint publication with Gregg Masters, MPH.
KevinMD
Kevin
Pho, MD, ACP Member, offers one of the Web's definitive sites for
influential health commentary.
MD
Whistleblower
Michael Kirsch, MD, FACP, addresses
the joys and challenges of medical practice, including controversies
in the doctor-patient relationship, medical ethics and measuring
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Medical
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Elaine Schattner, MD, ACP Member, shares
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culture. Her views on medicine are informed by her past experiences
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Rob Lamberts, MD, ACP Member, a med-peds and general
practice internist, returns with "volume 2" of his personal
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of an Internist
Justin Penn, MD, ACP Associate Member,
attended medical school at the University of Washington School of
Medicine and trained in internal medicine at the University of
Rochester, where he is serving as Chief Resident.
Prescriptions
David
M. Sack, MD, FACP, practices general gastroenterology at a small
community hospital in Connecticut. His blog is a series of musings on
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Kimberly Manning, MD, FACP,
reflects on the personal side of being a doctor in a community
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in (Medical) Education
Neil Mehta, MBBS, MS, FACP,
is interested in use of technology in education, social media and
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personal information and knowledge management.
White
Coat Underground
Peter A. Lipson, MD, ACP Member, is a
practicing internist and teaching physician in Southeast Michigan.
The blog, which has been around in various forms since 2007, offers
musings on the intersection of science, medicine, and culture.
Other blogs of note:
American
Journal of Medicine
Also known as the Green
Journal, the American Journal of Medicine publishes original clinical
articles of interest to physicians in internal medicine and its
subspecialities, both in academia and community-based practice.
Clinical
Correlations
A collaborative medical blog started
by Neil Shapiro, MD, ACP Member, associate program director at New
York University Medical Center's internal medicine residency program.
Faculty, residents and students contribute case studies, mystery
quizzes, news, commentary and more.
Interact
MD
Michael Benjamin, MD, ACP member, doesn't accept
industry money so he can create an independent, clinician-reviewed
space on the Internet for physicians to report and comment on the
medical news of the day.
PLoS
Blog
The Public Library of Science's open access
materials include a blog.
White
Coat Rants
One of the most popular anonymous blogs
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3 Comments:
I feel at least in my community, that Primary Care M.D.'s are being treated like highly trained housewives-we clean up the messes, patients come here because no one has sat down and explained what has happened/is happening to them. We notice that the reason why an INR is off is because of advancing dementia, even though the cardiologist has taken care of them 10 years longer.I am an internist, social worker,therapist, and Medicare wants me to deal with all this in 15 minutes-and then I get crud from a family member across the country when I tell them that their loved one is getting lost on the. way to the elevator.It's just wearing. I love what I do-but it has been made so hard to do well. There will be no one to take care of me the way I was trained. ced
Amen to both comments, but doctors' lack of respect for PCP's pales beside how patients treat them. As a hospitalist I have spent hours and hours trying to find PCP's for my patients--who appeared totally baffled when I asked them who would refill their scripts, juggle their multiple conditions and make sure that they got to the right specialist and not the kind their sister-in-law thought they needed. Socioeconomic group has nothing to do with it--the rich folks can't stand seeing somebody whom they don't consider to be a "real specialist", and the poor ones can't get an appointment with anybody good using that Medicare or Medicaid card.
Thanks for this post and your comments. A friend and I had a long discussion today regarding the inadequate care we were receiving from our PCPs and asking the question "Where are the MDs who practice the art and science of'Primary Care'?" It would be a privilege to collaborate with such a PCP. Thanks for being present.Your service is appreciated!
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