Does Primary Care Matter?

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We are running out of primary care physicians. In 2007, less than 45% of these residencies were filled[1]; since 1995, the number of these physicians has increased by only 1.2% annually.[2]

Primary care is the traditional linchpin of healthcare, but medical students are rejecting it. Why? The average family practitioner earns 25% of what the average cardiovascular surgeon earns; this is not lost on medical school graduates carrying an average debt of $140,000.[3]

Also, primary care is disfavored throughout medicine. Tom Campbell, MD, Chair of Family Medicine at the University of Rochester, was told when he chose family medicine that he should “not ‘waste’ a Harvard education.[4]” From research grants to deanships, from organized medicine to consulting opportunities, primary care physicians are at the bottom of the food chain. Yet these physicians are the linchpin of our system: They evaluate, diagnose, counsel, provide preventive services, refer, and coordinate care. Specialists' focus, however deep, is necessarily narrow, and a healthcare system predicated on primary care physicians referring patients appropriately to specialists won't work very well if there aren't any primary care physicians.

But nature abhors a vacuum, as does healthcare. Advanced degree nurses, pharmacists, and others are jockeying to fill the primary care gap. In many cases, they probably can – but not always. Organized medicine is sounding the alarm about these “interlopers” usurping primary care physicians' turf, but what is needed is not a turf war, but rather better pay, more research and teaching opportunities, and more respect for generalist physicians.

A linchpin is defined as something that “serves to hold together the elements of a complex.[5]” If there are not enough – or any – primary care physicians, the question is obvious: Who's going to hold it all together?

I'm Emily Friedman, an independent health policy and ethics analyst, and that's my opinion.