Why few internal medicine trainee doctors become primary care physicians. 5
Many primary care physicians in the United States now restrict their practice to “concierge medicine”. That happens in other countries too. Physicians want to provide better medical care to patients. But, on the other hand, a lot of patients are getting less and less face time with their physicians. Patients have less opportunity to meet their primary care physician. What would be the solution for that situation? Dr. Anton Titov, MD. That is a different issue. It is interesting. This month’s American Journal of Family Medicine published an article that shocked me. It says that of the people who do internal medicine internships in the United States, only 12% want to be internal medicine or primary care physicians. Dr. Marshall Wolf, MD. The rest are all going to subspecialties. Dr. Marshall Wolf, MD. The reason for that is sub-specialists have more prestige, better hours, and a lot more money. If we want to fix this situation, we have to do what was done in Great Britain. I happen to know what they did. They raised the salary for primary care physicians considerably. Then they had plenty of general practitioners. Dr. Marshall Wolf, MD. We are going to have to do that. When you have very few physicians, they are going to be very busy. When you have enough physicians, then their life will be more tolerable. I do think we have to address that. I will tell you a funny story. One of my physician-patients wrote a book about comparative health care systems. Then was on all the national television shows. He came back to talk to me. He was talking about money and physicians. Then he accused me of never talking about money. I told him I thought I had the best job in American academic medicine. I was a poor kid and never expected to make a lot of money. But since he pushed me, I said this. I did think it was unfair that as a senior internal medicine physician I made the same salary in a year what an ophthalmologist made in a month. He told me he was surprised that I was making that much money. Expectations! Yeah… You are going to pay an internist a one-tenth [10%] of what ophthalmologist makes. Then you say, “I wonder why people want to do ophthalmology rather than internal medicine”. But it is internal medicine that covers everything! Now, listen, it is fun. In some ways medicine is one of the few games with this rule. They pay more for the person who specializes in moving the rooks than for the person who looks at the whole chessboard. A conductor! Yeah. Do you think it will change? Dr. Anton Titov, MD. Ah, I hope so. Dr. Marshall Wolf, MD. We will eventually change. Right now American medicine is in flux because of what’s going on in Washington. But at some point we will have a rational medical system. People will look at the system and say this. “Dr. Marshall Wolf, MD. We need more primary care doctors than we need subspecialists. At that point they will figure out.They are going to have to change the financial incentives. I don’t think that will be easy, but there is plenty of money in the system. Money is just maldistributed. Guess who is paid better? Those who ‘move the rooks’ or those who ‘look at all chessboard’? Dr. Marshall Wolf tells a remarkable story on financial incentives in modern healthcare.
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