By: Ronke Olowojesiku
As children we are presented with the ever-daunting question of what we wish to be when we are older. Even now as students on the pathway to becoming health care providers, the question is unchanged: what do you want to be? Pursued constantly by this matter, we contemplate what to do with the medical degree that is our eventual end goal. We could be a surgeon and perform amazing, intricate procedures that allow us to see and repair the glorious and awe-inspiring vessel that is the human body. Or we can be an oncologist and serve as a nurturing guide while treating individuals through perhaps one of the most difficult diagnoses they will face in this life. We can be a cardiologist, gastroenterologist, psychiatrist, nephrologist – the possibilities are great and varying.
However, in this menagerie of distinct and mesmerizing titles it is all too easy to forget the physician who serves as the basis of our health system: the primary care physician, the physician who knows the life story of the patients, who knows them inside and out, not just in a health and wellness sense, but on a deeper level than most other doctor-patient relationships. Often times, these physicians are dismissed as merely a “jack-of-all-trades” and do not receive the prestige or respect their counterparts in medical specialties garner. In truth, this so-called “master-of-none” proves to be much more than meets the eye.
Primary care physician or PCP is a broad term used to describe generalists in the fields of family medicine, internal medicine, and pediatrics. These individuals, upon obtaining a medical degree, undergo three years of additional training in a residency program before being able to practice on their own. In their practices, they will see a wide range of cases and people. They will exercise preventive care – measures taken to avoid disease before it manifests itself – by encouraging patients to alter adverse behaviors such as smoking, inactivity, overeating, etc. In practicing this form of medicine, PCPs help prevent more serious diseases such as heart disease and lung disease that would impact a patient physically, emotionally, and financially while adding more stress to an already fragile health care system. When viewed in this light, the importance of PCPs is readily apparent, is it not? The ironic fact is, in a time when more PCPs are needed, fewer and fewer are available, revealing an alarming trend in the dynamics of medical education.
From 1998 to 2005, the number of U.S. medical school graduates entering into family practice residencies dropped from 73% to 48%, and by 2020, the American Academy for Family Practitioners (AAFP) estimates that there will be a shortage of 40,000 family physicians (Colwill, Cultice, & Kruse, 2008; Lloyd, 2009). With the first wave of baby boomers reaching retirement age now and changes to healthcare that will add another 47 million individuals to the system, now is not the time for a decline in PCPs (Lloyd, 2009).
But why are fewer and fewer medical school graduates choosing to enter into primary care? What exactly is the deterrent, if any? Well, like most things in life, the answer is not simple. In being a PCP, certain aspects of the job can be trying. The primary source of frustration for these doctors is the administrative work that must be juggled along with an increased amount of daily tasks and demands. And for all the headache, the gap between the salaries of PCPs and specialists has been widening over the years with PCPs being at the lower end of the spectrum (Woo, 2006). These factors combined are enough to see the problems that are leading to decreased numbers of PCPs. They also show something else: a general misunderstanding of the importance of the PCP.
The fact that medical specialists get more recognition and prestige is no secret. Even Hollywood resounds this reality with shows such as Grey’s Anatomy and House that are centered on medical specialists. A “sensible” medical student would consider specializing in a field over becoming a PCP. I too am guilty of this. But that attitude must change if we are to improve our health system as a whole. PCPs are the backbone of our health system, serving as gatekeepers to prevent disease and fostering a more healthy society. Now, does this mean we all should enter primary care? By all means, if you are that person who knew since the age of five that you wanted to be a pediatric neurosurgeon, go for it — if that is truly your passion. However, take care not discredit the primary care physician or count them out as merely a low-level generalist. The relationship I have with my childhood pediatrician is one I would not trade for the world. With her, I can share my most intimate concerns, both health-related and life-related. My relationship with her is incomparable to that which I have with any other doctor, showing how this particular jack-of-all-trades, master of none, is at times better than a master of one.
Colwill, J. M., Cultice, J. M., & Kruse, R. L. (2008). Will Generalist Physician Supply Meet Demands Of An Increasing And Aging
Population? Health Affairs, 27(3), 232-241. Retrieved September 23, 2012, from the PubMed database.
Lloyd, J. (2009, August 18). Doctor shortage looms as primary care loses its pull. USA Today. Retrieved September 23, 2012,
Woo, B. (2006). Primary Care — The Best Job in Medicine? New England Journal of Medicine, 355, 864-866. Retrieved
September 23, 2012, from the PubMed database.