Primary Care is not the same in every clinic.
There are two types of primary care: Easy and Difficult.
“Easy Primary Care” is what you see at a typical Urgent Care clinic staffed mainly with “physician extenders,” rather than actual physicians. These clinics take care of sore shoulders, runny noses, GI upset, cough and a lot of stuff which, frankly, never really needed a doctor in the first place. The patients tend to be younger. The moment the patient problem becomes even a tiny bit complicated, WHOOSH! Off you go to the Emergency Room!
“Difficult Primary Care” is becoming more rare these days. Let me clarify that point: “Rare” means hard to find. The demand for “Difficult Primary Care” has never been higher. It tends to be staffed by Internal Medicine Doctors, Pediatrician Physicians or Family Practice Physicians. The patients tend to be on a lot of medicines and require frequent monitoring. These patients have challenging medical problems like heart disease, cancer, COPD, renal insufficiency and difficult diabetes
.Unfortunately, “Difficult Primary Care” is a dying field. The reason is that it is really hard, poorly paid and frequently exhausting. No one wants to do it.
On the other hand, “Easy Primary Care” is… well… easy! You don’t even need to be a doctor to do it. Frankly, you don’t even need an NP or PA to do it. Your accountant neighbor could probably come up with just as reasonable advice on management for most “Easy Primary Care” problems.
We are witnessing a lot of tech and corporate firms entering the world of Primary Care, promising a superior patient experience. But, they only want to handle the “Easy Primary Care” stuff. If you have an easy primary care problem, your experience will, indeed, probably be faster and friendlier at one of these fancy medical startups, compared to a practice where the exhausted Internist is trying to handle a diabetic liver transplant patient’s congestive heart failure in the appointment before you.
But, the moment you develop renal insufficiency or CHF, WHOOSH! Off you go to a panel of specialists who will try to manage you without any sort of central direction from a competent and experienced primary care doctor. You will encounter conflicting instructions and opinions with no one to help you manage it all.
Those fancy primary care startups look good to only two groups of people: The patients who want a Z-pack for their head cold and the investment bankers looking to make a quick profit on the apparently insatiable demand for Primary Care.
The biggest need right now is “Difficult Primary Care.” When you need it, you really, really need it and you need it now. You don’t need an office that serves you Cappuccino Coffee while you wait. No! You need an experienced doctor with an ample knowledge base to not panic when your sodium drops below 130. You need a confident and steady hand at the wheel.
So, before you admire these fancy primary care startups from big corporations, ask yourself about the knowledge base of those providing care. Is this a place with real doctors or are they just hiring pretend medical people?
I currently work as a medical assistant at one of these Difficult Primary Care clinics and it is fascinating, albeit hard, work. I have been in healthcare for almost 13 years and I have learned more in the 3yrs with these doctors than I have in all the years before. We manage all types of complex conditions: CKD, CHF, DM, kidney stones, gallstones, different auto-immune conditions, routine care of course and basic urgent care. With COVID we were one of the only clinics that stayed open during the worse parts of the pandemic in Brooklyn, NY in the orthodox jewish community which was hit very hard. I have had the privilege of working with these incredible doctors who have taken care of their patients for 20+ years and the work we have done here has solidified my goal to become a primary care doctor. One of the doctors will have 30 complex patients on his schedule and he and I will stay until midnight twice a week to make sure everyone gets the time they deserve and yes, patients come in to be seen for routine care at midnight because they know they will be listened to and get good, often old-school medicine. It is really well-rounded, collaborative care and our patients know that what we do here is unfortunately uncommon. I have filled 4 notebooks with clinical notes to use in medical school and beyond.
What we will hear five years from now- “I used to have a primary care doc. I wanted an antibiotic for a cold, called, got no response, left three online messages, called every day for three days, started to feel better, roasted them on google and yelp, and then they sold out to a corporation.” I get fifty messages a day, well over half take 1-2 minutes but many 3-4. I cannot survive at this rate and am considering concierge or selling out. This is not what I signed up for.
Do DPC. We can help you.
Steven, every word you wrote is 100% dead-on correct. And no one with a brain would get anywhere near primary care any longer.
Agreed. I hope med students routinely read this page to be convinced not to go into primary care. The residency might be in the process of being “dumbed” down so there is no difference between a doc and an n.p. I don’t know that for a fact but I wouldn’t be surprised.