Being associated with a Caribbean medical school such as UMHS, I am, in general, passionate regarding prospective medical students’ choice of school, academic outcomes, standards, etc., not to mention being curious as to why people become doctors in the first place. I am also a healthcare consumer, and I am, as most are, concerned with receiving the best healthcare possible. As I sat waiting for my friend, Dr. Sam Merrick of New York Presbyterian Hospital’s, Center for Special Studies, preparing to interview him for this article on Primary Care Physicians in the US, I wondered if, with the looming shortage of PCPs (-50,000 by 2020), there was enough being done to address the issue. UMHS is certainly doing its part, but in the end, the choice of going into Medicine or a Specialty is up to the student not the school. In the near future, will there be enough students willing to opt for a life of managing patients’ overall care? I wondered if this supposed future isn’t already with us. I mean, just last month a friend in New York had so much trouble finding a PCP in his health plan that he had to start seeing a Sports Medicine Doctor!
When Sam arrived, he looked tired from a long day’s work. He usually has a huge patient load — maybe 20-30 a day, — seen in brief, intense visits. Add to this, calls to insurance companies and pharmacies, visits to the ER, counseling sick and dying patients and their families, advocating to social service and government agencies, making numerous referrals and having to do clerical work at the end of the day. Yes, I am sure he is tired.
Recently honored as one of New York Presbyterian’s Physicians of the Year, he’s good at what he does. I assume this not only because of the award, but also because he’s been doing it for more than 20 years. He knows his stuff. A brilliant man who probably could have been any kind of doctor he chose, yet he chose to be a Primary Care Physician in one of the most difficult areas of practice, H.I.V. and A.I.D.S. treatment. In the early days he saw a lot of patients die. But with the advent of better drug therapies, now he performs more of the duties you would think a PCP might perform, i.e, long term patient care.
I asked him to talk a little about what Primary Care is and what is the difference between that and a General Practitioner. The latter, he tells me, was a “jack of all trades,” a generalist who might suture a wound, treat someone with hypertension and deliver a baby in one day! Now the PCP is more of a care manager, providing a key source of preventive and ongoing care as well as referrals for more specialized treatment.
For patients, primary health care practices are the entry point to the system. More than just a ticket puncher to be sure, the PCP acts as advocate and advisor, providing support to patients beyond what medicine might suggest. They must, according to Sam, truly care for the patient.
Making the decision to become a PCP isn’t easy, especially given the long hours and lower than Specialist pay that Primary Care Physicians usually earn. A recent study by the Medical Group Management Association, found that while US Primary Care doctors earn an average of $202,947 per year, Specialty Physicians can see salaries above $358,000.
North Carolina State University surveyed more than 2500 students at two medical schools between 1993 and 2012. Their study found that many students decided not to become primary care doctors out of concern over anticipated debt. Individuals who expected to pay back higher student loans typically opted to find a job in a medical specialty, while those who had less debt chose to become primary care physicians.
I mentioned this to Sam, who balked at the idea that loans were the motivating factor for why a doctor chooses one direction over another.
“When I was in school,” he said, “I thought about being a Thoracic Surgeon. It seemed exciting. But my heart pulled me elsewhere – towards treating patients more directly, more intimately and ultimately, my heart won out.”
“It takes heart to be a Primary Care doctor,” he continued. “Not everyone is suited for it. Heart, patience and diligence are key. Also a good mind for details and a backbone for work. You really can get exhausted, depending on your patient load. But in the end, the satisfaction of really working day to day, face to face with patients – that’s what keeps me coming back for more. To be a Primary Care doc, you have to really want that experience.”
So where are the next generation of Primary Care Physicians? As the baby boomer generation ages and more Americans purchase health insurance, a growing number of people will need access to health care. The recent passage of the Affordable Care Act will undoubtedly place an even greater burden on an already strained system. Add to this, a growing shortage of seats in US and Canadian medical schools, and the pressure grows to answer the question.
Caribbean medical schools are certainly becoming a critical part of the solution, offering acceptance to qualified students. No longer just an alternative, Caribbean medical schools like UMHS who just recently received full accreditation from it’s host country, St. Kitts, are quickly rising as primary options for those wanting to study in environments personalized to their needs. Many of these students may be the answer to the need for highly trained Primary Care doctors.
Additionally in the Affordable Care Act, there are proposed financial incentives for those willing to practice general medicine, but if Sam is right, will that be enough to sway students who have worked their whole lives to become doctors, to consider joining the increasingly shrinking pool of PCPs? A recent article by a UMHS student, Dr. Kristen Riggs certainly makes a compelling case for it.
Similar to Sam, her training supported her commitment to patient care and paid off, as she was able to truly be there for a patient in need. Is this something that a Specialist could have done? Certainly. Is this something that many do? Absolutely. Yet it is the privilege of the Primary Care Physician to do it every day of their professional lives. Perhaps there is no way to quantify that in terms of salary. But as Dr. Sam Merrick, Physician of the Year put’s it: “It’s a privilege that money could never buy.”