The organizations who claim to represent these groups of doctors, namely the AAFP (American Academy of Family Physicians), the ACP (American College of Physicians) and the AAP (American Academy of Pediatrics) have failed to effectively coordinate their efforts to support primary care doctors. Too often, we've spent our energies promoting narrow agendas. Pediatrics claims the ethical ground as the ultimate advocates for kids. Internal medicine claims the "evidence" ground; they're rightly serious about the science of disease. Family practice claims the stump for the doctor-patient relationship and treating the "whole person."
All of this is noble and good-intentioned but fails to aim at the right target. Primary care is dying in this country. The average age of primary care doctors has increased significantly in the past 10 years and alarming percentages of those doctors want to retire early. Quality medical students are avoiding primary care to a degree never before seen. The vast majority of young doctors finishing their residencies are choosing to extend their training by a couple of years in order to specialize. It's an unsustainable situation largely ignored in the debate on healthcare. Until the primary care physician community that includes general internists, pediatricians and family physicians gets it's act together to advocate in a united way for our patients, the problem cannot be solved.
The size of our patients and whether we treat whole families or specific age ranges of patients may determine what tests we take when we become board-certified. It may have dictated which ICU we haunted during the endless nights of residency, but it does not define our responsibility to society. We hold a sacred trust to advocate for a system that supports accessible, comprehensive, personalized and coordinated primary care for patients. We need to get collectively focused on that. We need to stop angling for relative respect under the disrespected umbrella of primary care and start collectively leading healthcare transformation. Our patients deserve and want just that.
1 comments:
I definitely agree. I am an internist. I have been asked countless times "exactly what is an internist?" The name is bad. I've taken to referring to myself as a primary care doctor for adults, which people seem to relate to better. Then, I typically get the follow-up question: "how is that different from family practice?" I answer, "I don't take care of pregnant women or children, and my training was more hospital based." All that being said, we in primary care: Family Practice, Internal Medicine and Pediatrics, do need to unite to form a common voice, given the problems that you discuss with respect to recruiting medical residents to our profession. On Thursday of next week I plan to attend Doctor's Day at the Capitol in Atlanta as an advocate for ACP to speak with legislators. On my agenda will certainly be a discussion of the unique problems faced by primary care physicians within our healthcare system--primarily resulting from falling reimbursement from insurers coupled with increased bureaucratic demands.
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