Radical Primary Care Changes Needed to Meet Coming Demand for Health Care

March 24, 2013 Annals of Family Medicine
James Avantes in his essay "Radical Primary Care Changes Needed to Meet Coming Demand for Health Care" (March/April issue Vol.11 No. 2 184-185) mentioned several good radical changes that would make primary care more attractive including loan repayments, tuition waivers, scholarships, and pay increases. However, in addition to the changes he mentioned there are others that may sound heretical or even foolhardy, but they should at least be considered. For example, why not combine college and medical school into a six-year program instead of the traditional eight? It is not unreasonable to modify the basic sciences so that they are more practical. After all for most physicians, and particularly for those in primary care the time spent in organic chemistry, calculus, physics, and biochemistry is of questionable value. I have been in practice for almost 40 years and cannot recall any use I have had for those subjects. For students who have aptitude for research the sciences could be studied in greater depth, The real training for physicians takes place in residency and getting students into the hospital sooner makes more sense than spending time in med school. Primary care doctors could be turned out in eight years instead of eleven. This would get more of them into the workforce quicker.

Primary care has already been radically transformed by external forces in ways that are difficult to accept. For example the time and energy consumed by coordinating activities has superseded that which is devoted to actual patient medical care. Dealing with insurers, pharmacies, home health agencies, nursing homes, hospitals and a multitude of other tasks have come to almost define primary care. Clearly, there are some physicians who decide to practice in rural communities where they may be required to have a full spectrum of skills. For those who go on to do non-surgical orthopedics, OB-GYN, office surgery, pediatrics and hospital and nursing home care, a special fourth year of residency could be designed for them. If primary care physicians are not produced quicker and with training that prepares them for what they will actually be doing in practice, then advanced practice nurses will become independent primary care providers. Actually, they will be encouraged by lawmakers simply because there are not enough primary care doctors around to do the job. The shortage of primary care physicians is a problem that has been "impending" for decades and which during that time medical educators have ignored. Some believe that it is a consequence of Abraham Flexner's report (1910) on medical schools. His report set the stage for making medical research and specialization the focus of medical schools. This pattern has persisted for over a hundred years. If radical changes are needed for primary care, then primary care training has to be re-defined for the future. Simply paying these physicians more is not the answer. MDs will take on supervisory roles.

Edward Volpintesta MD

Competing interests:   None declared