Wednesday, July 01, 2015

Primary Care

I haven’t said it for a long time, so I’ll say it again.  If medicine was a science, there would be no need for doctors.  If one could stick a finger a machine and learn the diagnosis and best treatment, there would be little or nothing for anybody else to do.  But no such machine exists yet so doctors learn what science and technology can tell them and then resolve uncertainties and choose among alternative courses of action.

It seems to me to follow that since science and technology can tell much more than they could in the past, there is less for doctors to do and we should need fewer of them.

The matter arises specifically in the case of primary care.  The June 23 issue of The Boston Globe carried a rather lengthy article on the subject, titled Precarious future for primary care.  The article discussed the difficulties of recruiting physicians into primary care, given that the specialties pay better and can be less demanding.

In my last two ER experiences (nothing serious, only bothersome complaints at inconvenient hours) I learned during the visit that I was being seen not by a doctor but in one case by a nurse practitioner and in the other by a physician’s assistant.  In both cases my concern was properly addressed and I was completely satisfied by the service. 

Adding to that a reflection on what goes on during my unexciting, periodically scheduled routine visits to my regular primary care physician causes me to wonder whether we really need physicians for most primary care at all. 

Primary care physicians graduate from college, go to medical school for four years and then undertake two or three years of residency.  According to the article, the average salary of a physician in family practice is $196,000 per year.  There may well be a goodly number of people who could be trained to carry out the function satisfactorily in a shorter period of time and who would be happy to work for a lower salary.

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