Primary care physicians are generalists who are often the first to see/diagnose patients and provide them with overall care, often for many years. They serve as "gatekeepers" to other medical services by referring patients to specialists when necessary. Students and residents need to learn about a broad range of conditions and care for patients of all types and ages, which can be both rewarding and daunting. As generalists, they may require less initial training, but also earn less than specialists do.
Short Initial Training Period
All physicians must complete three to four years of college and four years of medical school. In addition, primary care physicians must complete three additional years of residency training to become board-certified, the Journal of the American Board of Family Medicine reports. Doctors who enter other specialties may need up to eight years of post-medical school training before they can start practicing.
Diverse Case Load
Primary care involves learning to treat a broad spectrum of acute and chronic health conditions in patients of all ages. This gives the physician-in-training the opportunity to learn first-hand about a broad spectrum of symptoms, treatment, side effects and how medical conditions affect the patient as a whole. Specialists, by contrast, focus more narrowly, typically treating only one problem or one set of problems. As one student explained anonymously on a student-doctor Web-based forum, through primary care training, "you get to interact with everyone and see all different kinds of problems, keeping you 'up-to-date'/maintaining your medical knowledge on most current diseases (instead of just say.... cardiovascular problems)."
Long-Term Relationships
Primary care training emphasizes the need for future doctors to get to know their patients well, develop long-term relationships with them and contribute to their overall quality of life. This is a big draw for many students. In an August 17, 2009 USA Today article, family practitioner Doug Dreffer, M.D., said that, although he's still paying medical school loans 12 years after graduating, "I consider it a privilege. I like people. I like relationships. That's what family medicine is about. It's not about doing procedures or a cool heart bypass. You get to be part of your patient's life story."
Low Earning Potential
Most primary care physicians earn far less than specialists do. This can make it hard for them to afford to pay medical school bills, which are often steep, even after graduating. "In order to make the high salary, doctors make a huge financial investment (e.g., an average of $140,000 in school debt vs. the average debt of $20,000 for college graduates)," Robert Doan, M.D., Ph.D., explains on the Medrounds.org Web site. He points out that physicians in non-surgical specialties make an annual salary of between $119,000 and $205,000, while surgeons average $192,000 to $299,000 per year.
Broad but Shallow Knowledge Base
Generalists find it difficult to develop a depth of knowledge in one area because primary care training involves keeping up on developments in many different areas of concentration. This forces doctors-in-training to acquire "a diversified knowledge base that lacks depth," another student explained on the student-doctor forum.
Lack of Professional Prestige
Medical school faculties often criticize primary care medicine as being shallow, and discourage students and residents from pursuing it, primary care physician Beverly Woo, M.D., reported in the August 31, 2006 issue of the New England Journal of Medicine. Medical students Luis Manriquez and Katherine Glas also said in a July 16, 2009 CNN article that there's a widespread perception among specialists that they do more for patients than generalists do. "Primary care doctors don't have a lot of status in the medical field," Glas said.
Lack of Business Logistics Training
Students and residents don't learn until they start practicing medicine that they may have to deal with three times more paperwork than specialists do, Ted Epperly, M.D., head of the American Academy of Family Physicians, said in the CNN article. Much of this involves filing insurance forms for reimbursement from Medicare, Medicaid and private insurance companies, he explained.
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