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Who’s Afraid of Primary Care?

I’ve never been particularly canny or shrewd when it comes to planning my so-called career.  Still, I couldn’t help but notice, as I was finishing residency training, my highest scoring peers were going into procedure related fellowships, or becoming hospitalists. I hadn’t given much thought to the next step. On the urging of my best friend, I applied for and accepted a job as a pediatric hospitalist at a local tertiary care hospital. It was a large hospital with a lot of growth and we cared for kids with all kinds of unusual and complicated problems. We ran a busy critical care transport service. It was sexy, as they say.

 And then life intervened, and I moved back home to join the family business. I work in a two woman pediatric practice in a county with about 100,000 residents. I figured it would be sleepy, but relaxing. Definitely not sexy.

Well, thanks to the Affordable Care Act (ACA), primary care is getting sexier by the day. Blue Cross Blue Shield representatives are offering to provide lunch for my office (a luxury usually reserved for dermatologists and ophthalmologists), marketing reps are tripping over each other just to be in my good graces, and college students are asking me about the path to medical school again.

At some of the best medical schools in the country, over 90% of first year medical students declared that they planned to join procedure oriented specialties like ophthalmology, dermatology, interventional radiology, or at the very least, anesthesiology.

Now, I mean no disrespect to procedure oriented specialties in medicine. But the fact is many students have been choosing those highly specialized careers because they pay better. Most students incur huge amounts of debt to achieve their goal. I often joke that I have a mortgage on my brain. So, when deciding how to spend the next 30 years of our professional lives, many of us have to consider those huge loans and the decades of payments ahead. Medical graduates have been afraid that if they go into internal medicine or pediatrics, they won’t be able to pay their loans and send their kids to soccer camp. It’s not greed so much as pragmatism.

Don’t misunderstand, I see it as a grand privilege to be able to practice medicine. I experience joy and satisfaction every day seeing the children and families in my practice growing and thriving. I get to solve problems. I meet amazing people and I serve as an expert on the most beautiful and amazing machine in the living world: the human body. Thanks to the ACA, incoming medical students can plan to practice their passion, instead of their wallet. And this will, albeit unquantifiable at first, will improve our health care system.

By 2015, there will be a shortage of physicians in the United States, mostly due to expanded access to insurance. Medicine will once again be considered a promising career and physicians will be more fairly compensated for their work – unless current political strategies to undermine the ACA succeed.

As it becomes more likely that the ACA will survive the state-by-state constitutional challenges, opponents of progress are changing their game. They are working to “de-fund” key provisions of the law since they can’t repeal it. They won’t even allow the task force assigned to address workforce issues to meet and make recommendations. The hope is that if, in 2015, seniors can’t find an internist  who accepts Medicare and children go without their well checks because their doctors don’t have time to see them, this will be seen as an ACA failure.

Thanks to expanded primary care training, changes in reimbursement patterns  and the adoption of the Medical Home model (all components of the ACA), medical graduates won’t worry quite as much about working too hard and being paid too little, if they practice primary care. We will no longer have to choose our pocketbook over our passion. This requires allowing the Affordable Care Act to move forward and be fully implemented.

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