Tsivya Devereaux: A medical student’s perspective on the primary care shortage

Income prospects and medical training do too little to encourage doctors to choose primary care.

“We need more physicians in primary care.” I hear this on a regular basis as a second-year medical student at the University of Utah School of Medicine. There is a recognized shortage of primary care physicians (PCP) in the United States, especially in medically underserved and rural areas. What is being done to get more medical students in primary care?

First, we have to look at what the PCP does. PCPs are generally family practice doctors and often the first interaction a person has with the medical system. The role of a PCP is broad, and their work is unrelenting. The standard allotted time for a PCP visit is 15 minutes, during which time they may be expected to perform annual check-ups and routine screenings, diagnose and treat illnesses, bring together information from other specialists and/or counsel on lifestyle changes to prevent disease. Equally important is making sure the patient feels heard, comfortable and respected. This strengthens the patient-physician relationship and allows for consistent health care delivery.

While the inclusion of physician associates and nurse practitioners has helped decrease the number of patients PCPs see, it has also added administrative and supervisory roles to their daily work. Because the physician supervisor is liable in the care of hundreds of patients that advanced practitioners are caring for, they lose direct interaction with their patients.

Additionally, the frequently cumbersome electronic medical record often requires that PCPs take their work home, amounting to hours of unpaid labor. All of these factors are contributing to overworked, overwhelmed and underpaid providers.

While income isn’t the only factor in a medical student’s decision to pursue a certain specialty, PCPs make an average of $100,000 less than their sub-specialist counterparts. And the rising loan burden is hard to ignore. While loan repayment options are available for physicians who choose primary care, PCPs are still making less.

Our health care system rewards physicians for easily billable items like procedures, tests and imaging rather than their time, expertise and diagnostic skills. PCPs perform fewer procedures than many medical specialties, but spend more time with patients in order to reach a diagnosis and refer to another provider if warranted. Therefore, physician pay is based more on the profitability of services offered than on the intangible heart of medicine represented by the PCP: establishing a relationship with the patient. There are many factors to improving a PCPs quality of life and quality of care, and income is part of that equation.

As a medical student deciding what specialty to go into, there are a few things I find important to making my decision. I want to work directly with patients. I want to practice what is most interesting to me, where I feel comfortable yet challenged. I want to feel helpful and useful. These aspirations seem within reach if I pursue primary care. Yet I rely largely on my professors for career guidance, and not a single one is in primary care.

There are often misconceptions, stereotypes and generally negative opinions of PCPs circulated within the medical school and among classmates. I’ve heard phrases such as, “You’re too smart to go into primary care,” or, “You don’t want to do just primary care, do you?” This disregards the substantial knowledge and skillset required of PCPs. Furthermore, in my experience working with justifiably jaded PCPs, their outlook can be a substantial deterrent to picking primary care.

If we want more students to choose primary care, we need to start treating primary care physicians better. They need to be paid in accordance with their expertise and saddled with less administrative and clerical minutiae. They should not be expected to regularly work from home unless this is an agreed upon part of their practice and compensated for appropriately. And we need more primary care providers teaching students in the pre-clinical years of their education so learners benefit from personalized guidance on the importance and rewards of this field of medicine.

When I pick my specialty, I want to put my patients’ needs first. But this is difficult when the medical system continually fails to put primary care first.

Tsivya Devereaux

Tsivya Devereaux is a medical student at the University of Utah School of Medicine. She is interested in primary care and a part of the Tribal, Rural, and Underserved Medical Education program (TRUE).