Questions About How We Train Primary Care Doctors

May 21, 2012
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Depending on who is talking we either have a shortage of primary care physicians or we don’t.

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Depending on who is talking we either have a shortage of primary care physicians or we don’t.

It’s hard to make a case for no shortage when you go to places like Prescott, Arizona.  Primary care practices there are full.  New residents often have to make the 80 mile trip to Phoenix to find a “medical home.”  Those who maintain there is no shortage usually fall back on the argument that we have a ”maldistribution of physicians,” which suggests that someone needs to tell many of them to move to rural, underserved areas if they want to practice.  ”After you,” they would say.

I am beginning to wonder, though, about the training we provide new med school graduates and how that factors into the equation.  I just finished reading an excellent article by Dr. Susan Okie in the New England Journal of Medicine, titled “The Evolving Primary Care Physician.”  The part that intrigued me involves “Reforms in Education.”  Dr. Okie relates a story that George Thibault, president of the Macy Foundation, told her.  Thibault who was once a professor of medicine at Harvard Medical School, says a primary care resident confessed she wasn’t going to be “comfortable” with an outpatient practice after her training at Massachusetts General Hospital.  In her mind, she was deficient in the proper skill set for providing ambulatory care.  If residents never leave the ICU, Dr. Okie quotes Thibault as saying, “They’re never going to have a comfort level to even imagine [working in a community setting],” let alone a rural setting.

Put yourself in this resident’s shoes.  She is finishing one or two years of a primary care residency and doesn’t feel comfortable with being a primary care provider.  What does she do now?  As Thibault notes, training should match what a student’s career pathway much earlier, or they’ll end up in a similar fix – unhappy and uncomfortable in a primary care setting.  I hope she is more the exception than the rule because my belief is that a person’s happiness revolves around the reason to get up every morning.  Thinking positively, perhaps once she starts seeing patients, she will resolve some of that discomfort.  But we don’t know that, and neither does she.