Category Archives: medical education

the primary care conundrum

Most informed people believe that successful health care reform won’t be possible without more primary care and less of everything else. Unfortunately, that concept has little to do with our present reality. We suffer from a severe shortage of primary care doctors, and it’s only getting worse. Last night NBC news anchor Brian Williams reported on why medical students at the University of Washington — America’s top-ranked primary care medical school — are forgoing primary care careers in record numbers. Ten years ago, 40% of U.W. graduates opted for primary care training. Today, just 13% of students make the same choice.

Williams suggests that maybe it’s a money issue; primary care physicians are said to earn an average of $190,000 per year while a spinal surgeon makes $611,000. Or maybe it’s the intense pressure for today’s primary care doctor to pack their schedules, to prioritize patient volume over quality of care, that makes students say thanks, but no thanks.  As one third year U.W. medical student noted, “I wanted to be a family doctor until I realized I wouldn’t be able to take care of patients the way I’d want to.”

In my opinion those are two sides of the same issue. We undervalue primary care — and as a society we pay for it. I’ll write more on this issue in weeks to come, so stay tuned. Meanwhile, check out the NBC video link above for footage of the Harborview Emergency Department, the setting for much of the action in House of Hope and Fear.

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new doctors

This past Wednesday was July 1, the yearly matriculation date for the profession’s newest doctors. It’s when newly graduated medical students begin to wield their M.D., when newly graduated residents become specialty fellows or practicing physicians. This year’s crop of new residents includes a few whom I mentored in past years, and they’re all going to be great doctors someday.

Which is to say that becoming a great doctor takes clinical experience. There’s no way around that fact. Great doctors have cared for thousands of patients. They’ve made a few mistakes, something nobody likes to think about — and have learned from those. That’s why some people say you shouldn’t get sick in July, because you’re liable to be cared for by an inexperienced intern.

Sounds kinda scary, doesn’t it? As a patient, you’re not looking to be somebody’s experiment. I get that. But I think it’s also important not to value a head of gray hair above all else. In fact, as a teaching physician, I often found that the typical July intern was scared to death and totally aware of all he didn’t know, which means he was comfortable asking for help. That’s good for the patient. You’ve got a concerned doctor who is going to keep asking around until the right answer arrives.

Later as trainees take on more responsibility, they don’t always sense their blind spots. And out in practice it’s all too easy to believe that you know the answer when in fact there’s a better or newer one out there. Or to have too much confidence or pride to ask for specialty advice. It’s possible to falter anytime — not just in July, and not just when you’re green behind the ears.

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continuing education

Last month I attended a medical conference in Chicago. I try to attend a couple of educational meetings every year to help keep my clinical practices up to date. Continuing education isn’t nearly as strenuous as medical school, which was an eight-hour marathon of class every day. With continuing ed, you stay in a nice hotel near famous museums and sights, and there’s lots of good eating nearby.

This time around I was particularly struck by just how much marketing to physicians went on. It wasn’t just pharmaceuticals — also being pushed were educational courses, employment opportunities, and a variety of consulting services. It’s awkward being targeted as a consumer when your intentions are as a learner. I was also sort of floored to realize that I probably learned as much getting caught up on my medical journals on the inbound flight* as I did during the meeting lectures — but the meeting’s what gets a doc her credit hours. Good perspective for those who insist we need drug companies and device makers to fund ongoing physician education.

*OK, admittedly my flight was re-routed through St. Louis, where the plane was grounded for hours waiting for thunderstorms at O’Hare to clear. So I had some extra reading time.

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