Sunday, May 25, 2014

Family Medicine

I’m returning home from a conference for continuing medical education.  Schooling never ends for a doc.  It’s a good thing because as medical advances are made, standard of care and treatments change with new research and discoveries.  Practices based in tradition are challenged to see if there is real evidence to support their continued use.

So anyways, as I sat in a room full of family medicine physicians reviewing basic dermatology issues often seen in primary care, I was struck with many thoughts… thus prompting this post.

It takes an average of 3 to 6 months to get my patients in to see a dermatologist.  Everyday, at least 30% of my patients come to see me for dermatology related issues.  The better I am at recognizing and treating various rashes and recognizing skin cancer, the more I can help my patients save time and money.  In fact, it probably helps overall health care costs for the country.

This applies to other fields as well… such as ortho, cardiology, endocrinology, etc.  So this is a shameless plug for medical students to consider entering this field.  Minus all the paperwork stuff that we get bogged down with… I find it extremely rewarding.  It is never boring and there is such a variety of things we do everyday…  like taking skin biopsies, suturing wound closures, incising and draining abscesses, injecting cortisone into joint spaces, or just being there to listen when someone is having an emotional personal life crisis!  In fact, psychiatry is the other field that I find very difficult to get my patients in to see.

There is so much to know to be a competent primary care physician but it also takes a calm, warm bedside manner.  This is often challenging in the midst of pressures to see more patients in less and less time.  Whether the recent healthcare law changes will affect the quality of care given is for a whole other post.

So I worry when I read things about more mid-level providers (nurse practitioners and physician assistants) taking over the role of primary care physicians.  Nothing against mid-levels, I’m sure there are many very competent folks out there… but the amount of time spent in schooling and the type of schooling is just different.  Why are there so few US medical student graduates going into primary care?  Well that is for another post as well, but it is all sadly related to money.  Our dermatology and psychiatry colleagues make twice or sometimes even more the amount the salary of an average primary care physician and medical school debt is medical school debt.

Well, if I had to do it again, I would not change fields.  For my type of personality, I like having the variety of things I come across everyday.   And unlike our emergency room colleagues (who also make about twice the salary) I also like the potential to cultivate relationships with my patients.
So for what it is worth, I love family medicine!  I think there is a very important role family docs can play in helping patients achieve overall good health without breaking the bank.




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