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Too Smart (and Just Right) For Primary Care

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I heard it all too often throughout medical training. Almost 17 years later, the sentiment survives that one can be "too smart for Primary Care."

Can you read an EKG? Tap a knee? Biopsy that suspicious lesion? Perform a colpo? Expertly whittle down a polypharmacy nightmare? Guide a patient from a life of obesity and insulin shots to weight loss and diet-managed wellness? Counsel and shed light through major depression? Manage kidney disease, heart failure, hypertension and contraception — all at the same time? Deliver a baby? Care for a baby? Treat adolescents? Manage HIV? Guide a patient through end-of-life care? Can you do all that and more?

Yes, you are smart indeed — and just right for primary care.

Primary Care physicians nimbly navigate the complexity of diseases in multiple organ systems. We fight unwritten battles through preventive care. We coordinate patient care amongst specialists and social services and throughout every level of the health care system. Primary Care providers are the first point of contact for most patients seeking medical care. Every day, we deliver health care in extraordinary ways that could never be adequately captured in the standard H&P.

The specialty of Family Medicine reached its 50th birthday on Feb 8, 2019. Although officially quite young as a formal specialty, the general notion of Primary Care has existed since antiquity. The earliest doctors drew on notions of herbalism, naturopathy, religion and physical diagnosis to heal all manner of ailments. They treated the whole person. Sound familiar?

In our recent history, Primary Care doctors have become more frequently visible as leaders in health care. Two of the last four surgeon generals, Dr. David Satcher and Dr. Regina Benjamin, have famed Family Medicine roots.

Even economic studies show the value of Primary Care. Landmark research shows that every dollar spent on Primary Care results in $13 of long term savings. Countries that assign high fiscal and social value to Primary Care have experienced this type of return on investment. And those same countries are enjoying higher quality of life because of it.

Primary Care Doctors Are:

  • Deeply and diversely skilled
  • The predominant entry point into the health care system
  • Direct descendants of the founders of medicine
  • Increasingly important in health care leadership
  • The best ROI for any country in the world

So where along our health care history did Primary Care become the ugly stepchild of medicine? When did Primary Care become the wasteland for smarts and professional passion? Why, despite our value, do we see a meager 4-7 percent of health care dollars going toward Primary Care?

At a time when the U.S. health care system faces a looming shortage of frontline Primary Care providers, we need a paradigm shift. In order to accomplish that shift — and to continue strengthening the foundation of health and wellness in America — we need all the smarts we can get funneled into this critical area of medicine.

So for all the smarties contemplating your path of residency and beyond, rest assured that your creativity and your passion — and yes, your intelligence — will be put to extraordinary use within Primary Care.

Yes, you are smart indeed — and just right for Primary Care.

Paulette Grey Riveria, MD, MPH, MBA is a family medicine physician-mom and entrepreneur.

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