Your voice: The future of primary care warrants discussion

June 15, 2019

Our readers speak out on recent articles.

I appreciate Dr. Alisha Scott taking the time from her busy practice to write her letter “Stop selling primary care physicians short” (Your Voice, May 10, 2019 issue) for my comments about the future of primary care.

Seeing patients “in the clinic, hospital, nursing home, and emergency room… [and doing]…operative vaginal deliveries, cesarean deliveries, postpartum tubal ligations, versions… [and] EGDs and colonoscopies” must leave her exhausted.

I notice that she and many of her supporters are from the western United States. I suspect that many of them practice in communities where specialty care is hard to come by. If that is so, I can understand why she and they are proficient in so many areas of medicine.

In my state of Connecticut, we have many specialists and I have many colleagues in primary care but none of them have practices as diverse as Dr. Scott. Many primary care doctors that I know are discouraged with the intrusions of insurers and the time-consuming distraction of electronic health records.

They also worry about the constant threat of malpractice suits (real or unmerited) which forces them to practice defensive medicine. Maybe these are not issues that affect primary care doctors in the Western United States.

But with the rapid advances of medicine and the emotional and social problems that doctors increasingly have to deal with, I stand by my comments which she disagrees with. I have been in practice for over 40 years and it’s all I can do to keep up with treating my diabetic, cardiac and hypertensive patients. I no longer treat hospital patients or those in nursing homes and I don’t see people in the emergency room. I make the occasional house call for an elderly patient.

It is a fact that medical students are turned off by primary care and those that do finish training are becoming employees of hospitals. There they face productivity goals and must comply with the hospitals’ regulations-both of which make it impossible to be the ideal primary care doctor.

As long as they practice within the limits of their training nurse practitioners can provide primary care and ease the strain on the traditional providers.

Primary care is multifaceted and probably is defined by what area of the country it is practiced, and the number of available specialists and the liability climate.

I believe that primary care training will be shortened so that a fully trained provider can be turned out in about six or seven years, bypassing the intense concentration on the basic sciences and focusing on training in community health centers. Those who will practice in areas where specialists are not readily available will probably pursue training in OB/GYN, minor surgery, and in doing EGDs and colonoscopies, among other things.

It is a great shortcoming that the leaders of primary care have not convened local meetings to discuss the future of primary care. I don’t think that they know how to define primary in the context of modern medicine.

Be this as it may, Dr. Alisha Scott has done a good thing by continuing this conversation. It is far from over.

To its credit Medical Economics is the only national medical publication that provides a forum for practicing physicians to participate in this primary care issue.

Edward Volpintesta, MD
Bethel, Conn.