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Why One Medical Student Chose Primary Care

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In our last post, we took a look at fourth-year medical student Mara Gordon’s piece for The Atlantic on why she’s decided to go into primary care , while many of her fellow students have not.

Part of the reason has to do with their training, during which they’re exposed mostly to specialty care. But that doesn’t completely explain why most medical-school students opt for specialty care, she writes. “…[T] here’s something deeper at play, a widespread and nagging perception that primary-care doctors just aren’t as smart as their specialist counterparts. A 2013 essay in the Annals of Internal Medicine asked the question most of my colleagues are too polite to verbalize: If you’re smart enough to do well in medical school, why would you go into primary care?”

It’s true, she concedes, that specialties like plastic surgery and ophthalmology are more competitive with fewer residency spots and higher test scores and grade-point averages required, while primary care has “more positions available, so fewer students vie for each one.”

It’s also true that the widespread perception of primary care works against it. Among medical professionals, there are several disparaging views at play: 1.) primary care lacks intellectual rigor; 2.) primary care is work that nurses or physician’s assistants could/should do; and 3.) in the words of one medical student, “A monkey could do this.”

Gordon also points out that popular media have fed a bleak perception of primary care to the public, one in which “[p]rimary-care docs are burned out, bitter, and leaving their practices behind for more lucrative endeavors... They forgo, on average, about $175,000 a year in salary compared to their specialist counterparts.”

She herself has entertained thoughts about choosing a specialty, but working with “one of the country’s foremost experts” in certain gynecological conditions showed her just “how frustrated the patients were, bouncing from specialist to specialist, seeing doctors in disjointed fits and spurts. Specialized care doesn’t always mean better care. For rare and complicated ailments, it is. But not for keeping people healthy, or for preventing disease in the first place.”

Gordon believes that medical schools need to place more of an emphasis on primary-care mentorship. One expert told her, “Students at schools with a positive ‘primary-care culture are connected with primary-care physicians, and practices, and can see something that they would want to wake up every day and do.’”

For her part, Gordon has a strong sense of why she wants to work in primary care.

She states, “I’m eager to work across disciplines to help keep patients healthy, rather than reacting when they get sick; I want to get to know my patients over time. There will be painfully rushed office visits in my future. There will be red tape and frustrations. But like many of my smart peers headed into this field, I also feel motivated by the challenges of designing new systems that meet the needs of patients, not the needs of insurance companies.”

For the primary-care physicians who are in our audience and looking for jobs, why did you choose primary care? Do you regret this decision? If so, why? If you don’t regret it, what keeps you going in spite of the many factors weighing against the primary-care physician?

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