Tuesday, November 11, 2008

My Pet Peeve of the Day

Anyone who reads EverythingHealth or many other health blogs (Kevinmd, Maggie Maher, Dr. Rob, Dr. Val, 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 and 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 want's to "see patients again" so he is going to do "primary care 1/2 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.


Anonymous said...


ERP said...

We get a lot of the same crap. "Oh, you really don't need to know that much about anything to work in the ER".
OK Mr ENT surgeon, lets see how well you deal with DKA and Hyponatraemia not to mention lets see how your multitasking skills are - since you will have to manage sometimes 20 patients at once with completely disparate diagnoses.

Anonymous said...

I'm lucky my doctor has yesrs of experiance seeing "live patients",
and really does care. I don't understand why there is a lack of respect for an Internal Medicine Doctor. Two of the doctors I know that I have the most respect for are a General Practice doctor and an Internal Medicine doctor.
And I have worked around many different specialities of doctors from working in the ER and in offices.

tracy said...

i admire my Primary Care Doctor (an Internest) sooo much that i am embarassed to make an appointment to go see him for several peoblems that need attention because i'm afraid they aren't important enough. (I don't hang out and "bug" him, don't worry...it's been over a year). He is so great...kind, gentle, caring and of course, extremely knowlegable. (Did i mention "cute, too...??) i live in fear he will decide to specialize because of the life a Primary Care has...but who could blame him? i would n e v e r think of any PCP as "just" a doctor..i admire all physicans sooo much, it is probably "unhealthy"...lol.

tracy said...

Dr. Brayer,
It's interesting you mentioned "diagnostic acumen"...do you ever read "Jordan-In My Humble Opinion" ? It is a fantastic blog by a Primary Care who writes wonderful stories and poems and just recently wrote about that exact topic. Give his blog a try everyone...you won't be disappointed!
thanks, tracy

Toni Brayer MD said...

tracy; thanks, I'll check it out

Anonymous said...

I couldn't agree more. As a neurologist, the retired neurosurgeons that practice neurology really tick me off too...

Anonymous said...

Sad thing is that 86 year old Surgeon is probably more competent that 90% of Family Practice, oh sorry, Family MEDICINE graduating residents. Seriously, have you ever talked to one? Make Forest Gump look like Albert Einstein. Whats REALLY scary is FPs delivering babies, talk about a horror show.
Frank Drackman,

Primary Care-ologist

Vijay Goel, M.D. said...

Its pathetic...I originally was going to be a preventive focused pediatrician...now there's a specialty with a sustainable practice model in today's system.

The pendulum needs to swing back...we have all kinds of lumberjacks working on trees, but no foresters looking out for the forest. The issue is that we need to reward investments that pay off in health vs. spend directed against hope.

The commoditization of primary care was what killed off the respected primary care docs...and showing who's different and can create a relationship will bring it back.

My sense is the new primary care looks more like a return to the '70's model (Jay Parkinson and digital+real housecalls) instead of the hamsterwheel we have today.

Time based payment and a revaluing of cognitive medicine will be required to make that a reality.

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