I was listening to an analysis of Primary Medical Care in the U.S. this afternoon. They said that primary care is getting largely shifted to Nurse Practitioners since no one is training to be primary care physicians anymore due to the low reimbursement by government and insurance companies. I have seen both good and bad care by mid-level practitioners. This analysis claimed that care by mid-levels is sometimes more expensive that by primary care physicians, as they are more likely to over-order often unnecessary tests, and are more likely to refer patients to specialists (consultants) since their depth of background is not as deep. It was stated that the average Nurse Practitioner has about 1000 to 1100 hours of clinical training, while a Primary Care Physician has about 11,000 hours of clinical training. What do you think?
@Don Alaska Can it be possible that there are large enough numbers of well-heeled folks in America who have and pay their own Doctors? If so, would that not provide incentive to enter the Medical Field? Unless I mis-read your post, I think you are saying less young folks are seeking careers as Doctors. Frank
IMO a PCP has little value in today's world. My PCP relies on a computer-based system to make his diagnosis and treatment recommendations which usually involve handing me off to a specialist for actual treatment. I think that in a few more years we will be able to go to the internet and perform our own diagnosis by entering symptoms, temperature, blood pressure, etc... into a simple decision tree that will provide a diagnosis and send a prescription to a pharmacy or schedule a referral to a specialist. Welcome to McMedicine!!!
Less young folks are entering Primary Care Medicine, @Frank Sanoica, but I assume the specialties and sub=specialties are still doing okay. There will be fewer pediatricians and family medicine doctors in the future.
I couldn't disagree with you more, @Beatrice Taylor. You don't say whether your PCP is a physician or a mid-level, but if they are strictly using algorithms to diagnose and treat your ills, then you have a poor PCP and you are being cheated out of quality care. Sometimes algorithms have a place, but they shouldn't be used routinely. I know so many people who try to diagnose and sometimes treat themselves online that get themselves into trouble and stress, and end up arguing all the time. The quality of trained doctors has decreased markedly since the 1970s due to a number of factors, and many doctors are too much attuned to testing instead of examining the patient, but there are still good docs out there and folks should find doctors they can trust, just like you should find a dentist or a mechanic you feel comfortable dealing with. WebMD and other sites are good for educational purposes, and an educated patient can be a good patient. You should know enough to make decisions regarding your care, but don't think that using a website is a substitute for someone who has trained for 10 to 12 years or more in any discipline.
It's ok for you to disagree with me that's what makes the world go round. My PCP is a genuine doctor of internal medicine that also sits on the board of a local hospital. IMO he is not much more valuable to me than the old school nurse I had in elementary school. When I was a kid we had what I consider to be a real doctor, he was called a general practitioner that would handle most anything without referring you to a specialist. That was probably not a good thing even in those days but it is what I grew up with and what I measure other doctors by.
Before I became eligible for Medicare my Primary Physician pretty much took care of all my medical care. Then when I signed up for my Medicare Advantage plan the PCP that had been my Doctor was not on the plan I picked so I had to find a new one. I love my new PCP...she is just like one of my daughters and takes wonderful care of both my husband and me now. I did find though that Medicare seems to want your PCP to send you to Specialists for every little thing and it's like they use the PCP many times just to tell you from the problems you are having what Specialist they are going to refer you to. I talked to our PCP about this and told her unless their were things she specifically couldn't do that we would prefer she handle most of our medical care, labs, etc. And she was surprised but pleased that we wanted her to be our Primary Care Doctor. So unless we do need to see a Specialist...like when I was having irregular heart beats...our PCP is handling the majority of our medical care...just as our old Doctor did. I think that this sending us to Specialists all the time is one of the ways our Medicare system is being defrauded sometimes. Often times the PCP can do the things the Specialist does on a first visit, like lab work, etc. Then if the lab work, etc. comes backs showing there are problems that a Specialist needs to handle...that is when a referral should be made. If there isn't a major problem...then there is no reason the PCP can't handle it. I don't agree that we won't need Pediatricians in the future. As long as people are still having children, those people are going to want their children to see Pediatricians.
Internal Medicine docs are not generally considered PCPs, although they can provide primary care. They are considered general specialists who address only adult non-surgical ills. An Internist shouldn't do much referring unless there are significant findings to indicate that. The referrals may be due to low reimbursement by Medicare. It is almost impossible for us in Alaska to find a primary care provider that accepts Medicare as the reimbursements do not cover the expenses and overhead.
A lot of medical care is being done by Physician's Assistants too. Generally, when I say that I have seen my doctor, she is actually a PA, but she is a whole lot more knowledgeable and willing to look into things that the general practitioner who I had seen previously.
@Don Alaska IMO, Doctors should have individual websites where patients provide personal "feedback", just like when dealing with the sellers on Ebay or Amazon! Weed out the misfits. Frank
@Beatrice Taylor And you are correct beyond doubt in assessing that care type as fundamentally valuable. Frank
I view the PC physician as the conductor of our medical orchestra. He is the first to spot irregularities in our lab results and then make a referral to a specialist for a diagnosis. I owe my life to a sharp PC that was instrumental in my surviving Prostate Cancer and then years later Non Hodgkins Lymphoma.