Hooked on Primary Care?
I am open to criticism here so let me have it. This doctor was portrayed in an article in Healio. I only found it because the head of the AAFP praised how it exemplified family medicine as a new member of their organization. This guy says all the right things:
I never had a clear vision of being a family medicine physician when I was younger, but following that desire to create a world with more equitable and safe spaces led me to family medicine before I even knew why, and I’m so grateful it did.
Primary care allows us to meet people in their most authentic and often vulnerable states. In what other specialty do we get to forge connections with other humans that go much deeper than episodic interactions?
Primary care is hard; there’s no way around that. But it is also a deeply rewarding and sacred profession, and I can’t imagine doing anything else.
Good on him.
I wondered where he is doing all this great work?
Wanting to be the most prepared to take care of everyone is why I chose a full-spectrum residency program in which to train — Grant Family Medicine in Columbus, Ohio — and it’s where I’ve stayed as faculty now for almost 7 years.
Yup, he never spent a day working in the real world. Sorry, dude, that’s not family medicine or primary care. Having a half-day clinic once a week and seeing a total of 10 patients is not the real world. Don’t get me wrong, we need faculty members at residencies and maybe he is a great teacher. Fine. But don’t go spouting off about saving the world by treating vulnerable patients when you have never been out there getting your ass handed to you.
Thoughts?
There are probably fewer F.P.’s/I.M. folks left that did what I did. Take hospital call at a rural hospital, did hospital rounds and saw people in the office. It got to me so much that I retired at age 64. Plus my lovely wife died and I had to takeover and care for a mentally handicapped son. Financial advisor said when I was age 60 I could retire at any time. We couldn’t take vacations as we didn’t know when our son would have a meltdown so I saved the money.
I lasted to age 64 a couple of years after my wife died. Oh I started out in Surgery and got canned after 3 years. Never argue with an attending. I was always friendly and respectful of the F.P. attendings and residents so when canned, I called an F.P. program director I knew. He said, “Sure Kurt, we’ll be glad to have you. Come on back!”
So I had 5.5 years of residency, 3 in surgery 2.5 in F.P. To say the least I was confident when I got out.
Shoot, I remember the vascular surgeon’s nurse in the multi-specialty practice I had my career at said to me that Dr. Savegnago is paying for Christmas that year.
I was auscultating carotids and such and found disease that needed carotid endarterectomies and aorto-bifems due to undetected aortic aneurysms. We had a cardio-thoracic and vascular surgeon out in outer Mongolia! I asked why the cardiothoracic guy came here to a rural area and he said he discovered that C-T guys burned out before age 60 and decided to do general and thoracic surgery in a rural area. His partner started out in F.P. but then went to surgery and later got board certified in vascular surgery. Oh man, I had an inpatient blow retroperitonally an AAA and to see these two masters work to save the patient’s life was unbelievable. The patient was pushing a healthy “80” and had to stay in extended care for 8 months. Got out and lived 8 years. Had some belly pain later and I said, “Screw it, you’re getting a C.T. scan.” Poor guy had pancreatic cancer and he was pushing 90 years of age. I told him and he knew the severity of the diagnosis. He said, “Well doc, I want to thank you for these last 8 years as they’ve been a blast!” When he left, I had to go into the bathroom and quietly cry
Oh, some of the older docs were probably hard of hearing, were past retirement age and a lot of patients with vascular disease went by them.
Oh I forgot to mention, the cardiothoracic surgeon where I was at in a rural area was trained to do C-sections as OB coverage was sparse! He’d grab me sometimes at the hospital to assist and the nurse warned me to keep my hands “out of the field”. Oh my gosh! I never saw an OB get a baby out so fast! Man when anesthesia said the mom was out, he cut so fast and we’d get a crying baby out and he’d be leisurely sewing up the uterus. Well heck as a vascular surgeon, he knew where the blood vessels were! I was grabbed several times to assist and boy watch a trained cardio-thoracic surgeon do a lightning fast C-section is unbelieveable. When anesthesia said, “Go” the baby was out in a flash.
He was supporting the OB’s and FP’s that did deliveries and when an OB person wasn’t around, would get called to do a C-section. He later told me he didn’t like doing it but did it to support the partners in the multi-specialty group I was in.
Did the fastest C-section I ever saw and that’s a good thing for the baby. When they’re ripe, get’em out!
Kinda reminds me of the priests at my Catholic university teaching us marriage and family living.
God bless ’em. And, when he mentioned equity and safe spaces, I knew his opinion was worthless.
That touchy feely crap – “ more equitable and safe spaces” – would have dissuaded me from considering primary care, and I wish I had known it was trending towards the sad malleability well before I stumbled into it. Add to this the eagerness of a faculty member who won’t have to pay his own overhead, and you’ve a perfect herd tool who will do whatever he’s told. His non-episodic interactions were doubtless perfectly in line with the CDC et al over the past 4 years, and he’s probably dreaming of the day the ABFM asks him to write MOC questions.
Little known is that the academic center administrators figured out 10 years ago they have bargaining clout and routinely receive twice or even 4z the reimbursement of those in private practice small groups. Family practice academics is paid more than private practice. Their call is less frequent by far.
Compare one weekend of call back up, which may not even exist if they have hospitalists, every 2 months, compared to the rural family doctor on call every other weekend.
I totally agree, Doug. After 40+ years working 50-60 hours a week, I have a lot to impart to medical students and residents. However, I’m not so sure being burnt-out makes for a good teacher. I would probably tell residents it’s not too late to consider dermatology…
Good point.
No matter what discipline, I never learned very much from teachers who didn’t do the job. You can have all the techniques and textbooks memorized, but actually doing the job you learn how to make it work for individual patients. Maybe he needs to take a sabbatical and actually go work in the field for a while. I’m sure it would open his eyes to all the things he isn’t teaching his students now.
It’s easier to criticize than to create.
Not sure to whom your comment is directed. If is to the members of this forum (especially to the post creator) you are obviously new to this platform. The comments critical of an academic with no real-world experience are coming from physicians who have created successful (one would assume) practices and are frustrated getting advice from someone who has never left a training environment.