For all the controversy surrounding health care policy these days, one key idea is so widely accepted across the political spectrum that it has almost become a cliché: we need more primary care doctors. Patients complain of the difficulty of getting an appointment, primary care physicians report overwhelming patient volume, and workforce projections depict a sobering, widening gap between future need and future supply of primary care doctors. To be sure, an influx of primary care doctors alone won’t bend the cost curve or suddenly improve population health. But without more primary care doctors, our health care system will continue to struggle to take care of an increasingly old and unhealthy population.
As a first-year medical student trying to figure out my future specialty, I’m living this issue. And whenever I mention primary care to other medical students, the specific response varies widely but the general reaction is always the same: wistful cuteness. Oh, primary care is so great, they say; we need more primary care doctors. Then they tilt their heads and give me a sweet, encouraging smile. Their responses remind me of how my college friends who are now management consultants react to my other college friends who are now in AmeriCorps.
Why this reaction to primary care? The main turnoff is obvious: a specialist can out-earn a primary care doctor by millions of dollars over a lifetime. However, I think there’s a bigger issue at play. As medical students, our self-identity is very much wrapped up in our professional future. Starting with our pre-medical studies, we are used to sacrificing personal and family time for the privilege of patient care and thus come to consider our work very much part of ourselves. We want our peers, then, to respect us for our career goals. And in medical-student-speak, “interest in neurosurgery” translates into “I am smart, tough, courageous, and will be the master of my operating room.” If I tell someone I am interested in neurosurgery, people turn their heads, intrigued. On the other hand, “interest in primary care” translates into “I am willing to be overworked, underpaid, and underappreciated because I want to treat patients in a holistic way”—and results in cute head-tilts and sweet half-smiles. We don’t like that. For the price of the same medical degree, we rather have higher social currency and have heads turn.
The way to increase primary care physician supply is simple: increase salaries. The Affordable Care Act made a step in the right direction. We also need to simplify billing, continue to incentivize the spread of health information technology, develop better communication between primary care doctors and specialists, and fix the many other issues that (rightly so) drive primary care doctors crazy. But beyond that, the social currency of primary care among medical students also needs to be dramatically raised. Teach for America (TFA) made an entire generation of top college students excited about teaching, not because TFA has increased teachers’ salaries or fundamentally changed the scope or practice of teaching. Rather, its primary achievement is convincing Ivy League college students that teaching in underserved school districts is reserved for tough, smart leaders who want to change the world. So college students began respecting TFA members and, in turn, wanting to join them. A similar transformation needs to take place for primary care among medical schools across the United States.