Primary Care Has Rewards Despite Hassles

By BENJAMIN BREWER
http://online.wsj.com

We’ve now trained a complete generation of doctors that cares more about lifestyle than anything else.

Medical students are choosing the ROAD to success, meaning Radiology, Ophthalmology, Anesthesia and Dermatology. By first year, many are writing off anything but a fast track to minimal call, high pay and the lifestyle perks that go with it.

Despite the monetary rewards, I think many of these docs are missing out on the best parts of medicine I get to see every day. Not everyone agrees.

The American College of Physicians has raised the alarm of an impending collapse of primary care. A 2007 survey found that 59% of family physicians would choose a different career path if they could go back in time.

That’s the backbone of the U.S. health-care system we’re talking about.

The reasons are well documented: long hours, unpredictable schedules, big med school loans, paperwork hassles and declining income compared with other medical specialties and the legal risks.

The future competition from retail clinics, various physician extenders and the opening of 200 Ph.D. nursing programs that will churn out “doctor nurses” is just a symptom of our health system’s ills, not necessarily a cure for them.

I worry that the true family doctor is an endangered species, at risk of being relegated to American history alongside customer service, reasonably priced gas, kids who rode their bikes to school and weren’t obese, and trick or treating at real houses instead of the mall.

In good conscience, I can’t tell future family doctors that the financial outlook for the kind of practice that I chose will improve. As much as I’d like to, I can’t tell them that Medicare formulas or payment rates from private insurers will be better in 10 years. Factoring in flat or declining payments, more than a decade of student-loan payments and demands on family time make a small-town practice a tough sell.

What sustains me in my practice is the importance of the work and the satisfaction of seeing patients get well and the kids grow up. You can’t hide from your results as a country doctor. I see nearly everyone I treat around town, and I like it that way.

A patient I diagnosed with cervical cancer a few years ago rode her bike by my house the other day. She was cured by the surgery I referred her for. She waved as she went on by.

Another patient carried a very busy toddler past me at a school program recently. I delivered the little boy eight weeks early and kept him stable until a helicopter came to take him to the intensive-care nursery at a bigger hospital in the next county. He turned out just fine.

I’m happy to report there are still places where doctors don’t shy away from coming in at any hour to help with an emergency. My colleagues rallied to operate on a pregnant woman who ruptured her uterus in the car on the way to the hospital last month.

We had five doctors, essentially a third of our medical staff, responding to her critical condition at 11 at night. We stopped her from bleeding to death and attended to her critically ill baby.

Without small-town doctors and hospitals, patients like her might die trying to get to larger hospitals farther away. We know what it means if we’re not there and it keeps us pushing on.

A boy I helped deliver more than 10 years ago had a triple in his Little League baseball game last week. I remembered at birth his shoulders became wedged in the birth canal, and we worked 1 1/2 minutes to free him. He still has those broad shoulders, and he can really hit a ball.

The fun is in the follow-up. Doctors who never see the rest of a patient’s life are missing out.

I try to share the joy of small-town practice with medical students who come to work with me during their training. For some, holding the first baby they delivered independently forms a deeper connection with the wonders of medicine. Sometimes it’s sharing in the success of a critically ill patient coming around that does it.

Some, like me, revel in hearing the stories of the patients that show true healing is more than writing a prescription or doing a procedure.

A few students are concerned that after a few years, what seems to be a calling to a medical career might turn out to be just another job. That might be the case for some people, but it hasn’t turned out that way for me.

• Due to his schedule and the volume of email he receives, Dr. Brewer may not be able to respond to all reader email. He does participate in his forum, where readers are urged to post. His email address is thedoctorsoffice@wsj.com.

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