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A reader comments on the difficulties of practicing primary care medicine in today's healthcare system.
In response to “Many top hospitals lag in graduating PCPs” (August 10, 2013), primary care students are not being taught the skills they need for the future because primary care has been undergoing an identity crisis for more than 20 years and medical educators have done little to acknowledge the fact.
Over the past several years insurers’ intrusions, the burgeoning amount of administrative tasks heaped on physicians’ shoulders, and the dissociation of office and hospital practice have combined to radically change primary care physicians’ roles.
Some physicians say that the time and energy consumed by administrative toil has made them about 30% less effective. For example, dealing with pharmacies, home health agencies, and Medicare, to name just a few of the entities competing for their time, has made them spend almost as much time on paperwork as on actual medical care.
There is a high burnout rate among primary care physicians as they struggle to maintain the “do it all” image of the doctor of earlier times with the overworked modern version.
Many are in denial, but some readily admit that too much paperwork has taken away their enthusiasm and job satisfaction and that they would not recommend a career in primary care to their children.
Also, allowing nurse practitioners (NPs) to practice some aspects of care within the scope of their training and education would spread the workload among more providers and be more manageable for all.
Thus the fact that our best hospitals are not training enough primary care doctors is not surprising. It seems natural for these doctors to be trained outside of the hospital and to have NPs share in providing primary care services.
Edward Volpintesta, MD