No Family Docs Left

Here is an interesting blog from the NY Times.  Somehow, they just realized that there aren’t enough primary care docs around.   If you can’t read it then let me highlight some points:

  • For starters, only 2 percent of all medical students in a recent study expressed interest in practicing primary care as a general internist.
  • And once trained, primary care practitioners are particularly vulnerable to burnout and more likely to leave clinical practice than doctors in subspecialties like cardiology or gastroenterology.
  • What the researchers discovered, however, was that over the course of their training, almost half the young doctors who began wanting to become primary care doctors changed their minds, most deciding to pursue a subspecialty career instead. And by the time the three-year residency was finished, those numbers dwindled even further, with only one out of five indicating that they wanted to become primary care physicians.
  • “The environment is such that even the primary care track training programs don’t have a fighting chance,” said lead author Dr. Colin P. West, an associate professor of medicine at the Mayo Clinic in Rochester, Minn., and associate program director of the internal medicine residency training program.
  • Much of the problem lies in what general practitioners have to look forward to. General practitioners work as many hours as, or more, than their subspecialty colleagues. Yet they have among the lowest reimbursement rates. They also shoulder disproportionate responsibility for the bureaucratic aspects of patient care, spending more time and money obtaining treatment authorization from insurance companies, navigating insurers’ ever changing drug formularies and filling out health and disability forms.
  • “All the paperwork,” Dr. West said, “interferes with the patient-doctor relationship that drew them to general medicine in the first place and pushes trainees away from primary care unless they are remarkably committed to its goals.”
  • “If we go with the simplistic view that opening more medical schools and more training slots will give us more primary care doctors, we may get a few more, but we’re mostly going to end up with more subspecialists,”
  • “The residents are voting with their feet,” he added. “And they are telling us something really important.”

This blog is not just about my plight or the plight of doctors.  This blog is also about how the idiots in charge of our healthcare system have screwed it up so bad that it also affects the public.  People may sneer and not care about the loss of primary care docs but it will bite them in the ass.  There are less and less around to take care of THEM!  Down here in Virginia, where I am, there seems to be an extreme need as many people I see in the urgent care center don’t have  family docs.  And it will only get worse.  Trust me, this is a major crisis and the NY Times piece only was the tip of the iceberg.



Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  6 comments for “No Family Docs Left

  1. Ben Van Raalte
    January 2, 2013 at 12:50 pm

    Start by CMS only funding the first three years of residency or only funding primary care residencies.

    No need to fund radiology residencies at 50k a year for 40 hours a week for 5 years

  2. Kurt
    January 2, 2013 at 10:50 am

    I have 10 years to go unfortunately. There is no financial incentive to patients to straighten up their acts. The payors expect us to take responsibility for patient’s shitty habits.
    The uncompensateable paperwork generated by the “electronic” system
    (spell that computers) is “un-f’ing believable”. The scenario where Joe Blow is getting back surgery or some ortho procedure and shows up in the primary care office to “fill out” the disability paperwork is far too common. I don’t know how the hell long they’re going to be off from “XYZ” procedure. The reason that no students are looking at primary care is that they 1. Don’t get paid. 2. Like it or not, it will be taken over by Nurse Practitioners. 3. We’re getting kicked out of the hospital because no one has time to type in the f’ing orders. 4. With number 3. we’re being confined to the office and doing the work that the insurers think number 2. can do though an M.D. is more capable. I TELL all the students to stay away from primary care and I expect there are a fair number of practitioners who are doing the same. The pablum that, “You’ll be paid less but you’ll have more time off ” is bullshit now. You’ll be paid less, work more, take more responsibility and do more uncompensatable paperwork. The ABFM and AAFP is a bunch of grey-haired peopled who don’t work in the trenches anymore. They need to stand for patient responsibility and get the tools out there so doc’s and the patient educators (spell that diabetic teaching which currently is not paid for) get paid to get it done. If the patients ignore their health, too bad for them. Patient apathy is pandemic. It if wasn’t, we wouldn’t have an obesity, COPD and diabetic epidemic we’re currently dealing with. Change the equation and hit them in the pocketbook for bad habits and you’ll see a change in behavior and willingness to listen.

  3. Frank Lawler
    December 31, 2012 at 6:27 pm

    Amen. Bureaucracy and government are the direct cause of my retirement at the age of 57, 6 months ago. I had always thought I would practice till I was 80. The patients are wonderful and gratifying, but who needs the regulations and EMR?

  4. lagaya
    December 31, 2012 at 3:01 pm

    I think one of the things that motivates a person to become a doctor is that they want to do good. Primary care is the least likely area to do really do that. It’s the domain of the mundane. Really interesting cases and really serious cases get handed off to someone else who gets to do the heroics. I’m not in the medical field, but these are my impressions. Runny noses and constipation aren’t that thrilling!

    • Doug Farrago
      December 31, 2012 at 5:19 pm

      I understand your point but the truth is almost all diagnoses are made in the primary care docs office. We are the first one in the trenches to discover them and then send them to the specialists if we need help. Our problem, obviously, is that we don’t market this well.

      • Kurt
        January 2, 2013 at 10:55 am

        Common things are common and there is nothing wrong with dealing with those problems. I see a problem that is way out of my league, I take great satisfaction that I did as much of a workup as I could and set it up for the consultant to takeover and make a diagnosis and/or change
        the treatment.

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