The doctor practices in a medical shortage area, where the hospital administration has failed to sufficiently recruit and retain hospitalists. Here’s a portion of what he wrote:
"Not surprisingly, the recruitment and retention problem hit the hospitalist program simultaneously. Three hospitalists are now expected to manage 24-hour coverage with no relief in sight. And instead of offering the degree of compensation necessary to bring more physicians on board, the administration exploited the sense of crisis to convince the medical staff to consider opening the doors to Advanced Practice Nurses. This was the only solution, we were told, to the hospitalist shortage. The only way to stop taking extra call for free.""At this meeting, 100% of the subspecialists voted for allowing APNs to practice in the hospital. 75% of the primary care physicians dissented. The vote was overwhelmingly in favor of the measure. This happened in a system where some primary care doctors are making less than they would if they took a new position in a major city, and more than a couple subspecialists make seven figures. The abandonment of the greater medical good by our specialist friends eager to expand their already-overflowing coffers has filled me with renewed vitriol."
His rant has struck a chord in the medical blogosphere.
The Physician Executive wrote this response:
"Many U.S. doctors feel that primary care is the choice of students
with no other choice. Even Canada’s social conscience cannot mask the
prejudice entirely. … It is a nearly universal phenomenon in a world
where progressively greater expertise gets more respect than being a
generalist. Why else would family physicians so urgently proclaim that
they are specialists and not generalists? Paul Starr characterized
physicians as inveterate social climbers. A disregard for fellow human
beings, especially well-educated colleagues, is a hallmark of the need
to climb a social ladder."
"Medical science at the turn of the last century had so much
promise. As a profession, we are accountable, but we lost our way
during the 50’s, 60’s and 70’s. Medicine got more technical, more
complicated and we forgot that William Osler human ability to listen to
the patient’s story and consider the context of a life before
recommending treatments. We did not meet the expectations of many
stakeholders, no matter the fact that some of those expectations were
unreasonable to begin with. Some of us sacrificed the profession’s
autonomy and its beneficent role in society, with full wallets and a
family legacy, but not much else."
Are these just angry, bitter doctors, or are they being honest about the dismal prospects of primary care? People speak in platitudes about reforming the physician reimbursement system to value primary care, but if the reality is that the medical community views primary care as "the choice of students with no choice," any reform is dead before it has begun.