Pre-med students choosing speicalties

By Kacie Safford

Medical school graduates packing an average of $140,000 of debt may need more of an incentive to practice primary care than simply a passion to help mankind.

According to the Journal of the American Medical Association, just 2 percent of nearly 1,200 fourth-year students surveyed planned to work in primary-care internal medicine. This means the U.S. could face a shortage of up to 44,000 family physicians and general internists in less than 20 years.

Among the hectic clinical atmospheres, excessive paperwork and insurance hassles, the shortage may be largely provoked by a single factor – money.

A specialist who performs a procedure in a 30-minute visit can be paid up to three times more than a primary care physician discussing a patient’s diabetes or asthma in that same 30 minutes. In a single year, the typical beneficiary saw a median of 2 primary care physicians and 5 specialists. As doctors are racing to meet demands, reimbursement is coasting toward the quantity of services delivered, rather than the quality.

“Future generations of family physicians are becoming more limited as to what they can do,” said Dr. Kerry Welch, a family physician at American Fork and Timpanogos Hospitals. “Typical procedures for family physicians are going out the window because of fields of expertise.”

But the differences in primary care can differ between rural and urban areas. Dr. Brent Jackson, a general physician in rural Fillmore, said there isn’t much he doesn’t do.

“The lifestyle and details of your work depend a lot on where you practice,” Jackson said. “Sometimes you’re making house calls or getting paid in hair cuts,” he said jokingly.

For Jackson, quality of life and salary do not make for any toss up. He said the unique “small town” doctor-patient relationships alone are rewarding enough for him. However, he said rural areas across the nation won’t suddenly become hot recruiting spots anytime soon. Jackson is the medical director of three hospitals where three family physician positions have gone unfilled for almost a year.

As fields of expertise become more specific, more and more people are opting to skip the family doctor and head straight for the specialist.

“You go to a family physician for a sore throat or some transitory acute illness,” said Susan Lehnhof, a microbiologist at Mountain View Hospital. “Anything bigger, I go to a specialist. I want someone who takes out 5 tonsils a day, not someone who takes out 5 tonsils a year.”

But most family physicians see a lot more than just runny noses and earaches. They’re quick to say they are required to know something about everything under the spectrum of illnesses they see.

“Primary care is a lot of sorting people,” said Ryan Vellinga, president of the BYU Pre-Med Club. “You don’t get to do as much of the cool stuff. … On the upside, as shortage increases, those who are in primary care can become more valuable for the people who do it.”

Vellinga thinks this shortage is a trend now, but that it will take care of itself.

“As long as it is a free market, primary care will not become obsolete,” he said.

Copyright Brigham Young University 15 Sep 2008

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