None of these or the other often cited reasons are why I won’t go into primary care.
The simplest way to put it — primary care doesn’t live up to its promise. Primary care is supposed to be about developing long-term relationships with patients and being with them on the front-lines of dealing with their health problems (with a healthy dose of preventative care). Who wouldn’t want to practice medicine like that?
Unfortunately, it seems this is very rarely what happens in primary care. Patients move. Their insurance coverage changes. They develop a complicated chronic condition and begin seeing a specialist as their primary care. One of your patients is hospitalized, but their care is handed off to a hospitalist. Another patient comes into your urgent care clinic because they work and sees your partner. Other times you’re covering the urgent care clinic, seeing any and all patients in your practice.
Soon, you’re churning faceless patients through your practice with no personal connection to any of them. Is that how you want to practice medicine? Most medical students don’t.
When Boomers retire or die, the profession of primary care dies. I’ve been speaking with a number of large delivery networks lately and I ask them one question– what is the average age of your primary care docs? They say about 56. In five years those docs are going to be so burned out they’ll retire. Primary care is going to be in a very sorry state about the same time the mandates go into effect. There’s going to be a wave of retirement in sync with a wave of 35 million newly insured people looking for a doctor they’ll never find. And all of this is mandated by our federal government. They dropped the ball 20 years ago by adopting policies that paid specialists far better than primary care. They’re mandating that we pay into a “System” when the “System” isn’t really a system, it’s an industry not designed to function as one well-oiled machine for the good of our citizens, but an industry in business to profit off sickness.