10 Things Your Primary-Care Physician Won't Tell You
1. "They should put me on the endangered-species list."
A good primary-care doctor -- someone to coordinate your health care, help choose your specialists and be the first to diagnose just about any problem -- is the key to good medical treatment. But they're getting harder to come by. According to a 2007 study, it took new patients in Massachusetts an average 26 days to land an appointment with one. Why? Fewer med students are going into primary care: Interest is so low that the number of primary-care internal medicine residency positions dropped by more than 50% in the past decade. "We're not really getting the best and brightest in primary care," says Kevin Pho, a Nashua, N.H., physician who writes the blog Kevin, MD. "And that's where they're needed."
One big reason fewer medical students are specializing in primary care is pure and simple economics. In 2006 primary-care doctors earned an average of $171,519. That might sound like a lot to most working people, but it's less than half of what dermatologists made that same year. And the call of more-lucrative specialities is only likely to get louder for today's residents: According to one study, the income of primary-care doctors, adjusted for inflation, actually fell by 10% between 1995 and 2003. "Students are not dummies," says Pho. "They graduate with $130,000 in debt; why should they go into primary care?"
These days it seems like a visit to the doctor involves little contact with an actual doctor. Instead, most of the time is spent explaining problems to assistants and having blood drawn by nurses. Indeed, doctors have been beefing up their support staff -- physician's assistants and nurse practitioners -- to help them squeeze in more patients. They say this assembly-line approach is necessary because they get paid about the same for each patient no matter how long it takes. It certainly has been effective; some doctors are able to see 40 patients a day. That's one every 12 minutes. And it doesn't show signs of slowing: According to one survey the average number of patients doctors saw grew by 7.5% from 2004 to 2005.
Your physician relies on his best judgment when deciding what drugs to prescribe. And influencing that judgment is big business. Market-research firm IMS has found that the pharmaceutical industry spends $7.2 billion a year targeting doctors with ads and sales representatives. That translates into $8,000 in marketing money spent on each of the 900,000 doctors practicing in the U.S. today. "The introduction to pharmaceutical representatives starts as early as medical school, and it never really stops," says Pho.
When Mary Furman got a call from her daughter's school at 10 a.m. one day last year, she was sure it was strep throat, but her pediatrician couldn't see the girl until 4. Furman decided to try a new clinic she'd noticed at a nearby Wal-Mart; they were in and out with a prescription in under an hour.
Continued: 6."I Hate Technology"