PRIMARY CARE: THE FRONTLINE OF MEDICINE

BY GRANT MERCER – The fourth-year medical school students gathered around a table in the Vanderbilt Medical Center cafeteria. Over hurried bites of salads and sandwiches, the topic of conversation was the same one hashed over daily by most fourth-years – Who’s choosing what specialty?  Neurology, dermatology and emergency medicine were all hot contenders among the future doctors, but family medicine was, for most, not on their radar. At many medical schools, students have stigmatized primary care as unchallenging and meant for those unable to handle the demands of specialized care. A false stigma, indeed, as primary care physicians are tasked with mastering the entire breadth of the human body, rather than specializing in one particular organ.

        One Vanderbilt medical student who did choose primary care questioned his choice at a recent get-together brimming with fourth-years. Another classmate, choosing to pursue orthopedics, quizzed the student as to why he would waste four years of medical school by becoming a family doctor. Attracted to primary care by the long-lasting connection to patients and its ability to positively influence wellness, he still left the party wondering: “Am I selling myself short?”

        By the year 2025, the American Association of Medical Colleges (AAMC) predicts a shortage of 50,000 primary-care physicians. “The doctor shortage is real and it’s particularly serious for the kind of medical care that our aging population is going to need,” AAMC President Darrell Kirch noted. Over 50 percent of all doctors’ visits are made to primary-care offices, according to the Centers for Disease Control (CDC), but only 30 percent of U.S.  physicians practice primary care, down from nearly 70 percent in the 1970’s. The Veterans of Foreign Wars (VFW)  health care scandal of 2014 occurred when veterans suffered needlessly, in part, due to unreasonably long waits to see physicians. There simply were not enough general practitioners within the VFW health care system to handle the patient demand. Indeed, the VFW’s 2014 Congressional report cited numerous cases in which veterans had to wait 12 months for an appointment with a general practitioner.

        To alleviate the shortage, the AAMC has proposed federal support for an additional 3,000 new residency positions each year for the next five years. Since 2010, medical schools have been increasing their class sizes, but the number of residency positions has remained roughly the same. Fear of a doctor surplus prompted a 1997 payment cap on Medicare funding for residencies, which has served as a stumbling block for doctor training ever since, according to the New England Journal of Medicine (2013). This bottleneck has stymied the number of primary care residency slots available.  Congress must approve an increase in financial aid for new doctor training if the United States is to meet the demand for general practitioners.

        Primary care physicians are the gatekeepers to a healthy population. These doctors develop a comprehensive understanding of each person’s needs, working to keep patients healthy rather than always reacting to ailments. Individual patients, as well as overall public health, benefit. As for the Vanderbilt student who questioned if he was selling himself short by pursuing primary care: the answer is a resounding no.