A primary concern
A primary concern
When Dr. Michael Adler chose a career in family medicine more than three decades ago, he had fewer options to weigh than an aspiring physician in 2009 deciding between primary care and a medical specialty.
“It wasn’t that big a difference when I made a decision, because I made the decision in 1973,” he said. “Things weren’t anywhere near as discrepant as they are now.”
Adler, 62, works in family medicine at the Wake Forest University Baptist Medical Center in Winston-Salem., and the discrepancy he mentions involves compensation. Primary-care physcians (PCPs) and specialists drew roughly equivalent annual salaries when Adler took his Hippocratic Oath, but today that choice can make a difference of $200,000 a year or more — an especially important consideration given the load of debt most new doctors tow behind them out of medical school.
“I was paying in-state tuition, and tuition was $125 a semester,” said Adler, who went to medical school at the University of Illinois in Chicago. “There’s a direct correlation between the amount of debt these kids have and the amount of them choosing specialties.”
That debt helps explain a shortage of PCPs at the local, state and national levels. Moses Cone Health System commissioned a study by Navigant Consulting in 2007 that showed Greensboro would need about 30 additional PCPs over the following five years, according to Rebekah Driggers, manager of physician and specialty recruitment for Cone. According to the study, there were 192 primary-care physicians in the Greensboro area in 2007.
“We have made some headway on that,” Driggers said. “Their recommendation is to bring six in each year.”
The 2009 president of the N.C. Academy of Family Physicians, Dr. Robert Rich Jr., has experienced the shortage firsthand at his own practice in eastern North Carolina, Bladen Medical Associates in Elizabethtown, and he hears similar tales from across the state. Some practices offer incentives to lure PCPs to town, such as help paying off student loans.
“Of course, then someone has to come up with the funds to do so,” Rich said. “That’s where it’s rough from a business standpoint.”
And the cost is often steep. The $125 a semester Adler paid for tuition in the early 1970s has mushroomed exponentially. According to aamc.org, the Web site for the Association of American Medical Colleges, annual tuition and fees at state medical schools in 2008-09 average $22,099 for state residents and $42,177 for non-residents. At private schools, tuition and fees average $39,320 for residents and $39,778 for non-residents.
The Web site notes that those figures do not include housing or living expenses, but it also states that they shouldn’t discourage students from becoming doctors because there are several grants and loans available to assist with cost.
What’s considered ‘primary’?
Primary care most commonly refers to internal medicine doctors, who mostly treat adults, and family physicians, who treat people of all ages.
These days, between the shortage of doctors and the realities of insurance reimbursements, PCPs spend most days bouncing from one exam room to the next to squeeze in the heavy load of patients. While such a schedule can be stressful, PCPs say it also allows them to put their training and brains to good use, assessing a wide variety of ailments in a relatively short time.
“I’m the first medical contact that a patient has with the medical system for problems they’re having that are not for the emergency room,” Adler said. “It’s that first-contact nature that by definition makes us ‘primary.’ I see people also who have not had the cause of their problem defined by medical testing. I see people not because they need a heart doctor or a kidney doctor — I see people because they feel bad. My job is to figure out not only why that is, but also try to help them feel better.”
Primary vs. speciality
Like in other professions, there are trade-offs in choosing to specialize in a particular area. If you are interested in working closely with patients and tackling a wide variety of illnesses, primary care offers more opportunities but less pay. Specialists make more money, but they also rack up more debt because they have to go to school for longer.
Primary care “doesn’t pay as much,” Driggers acknowledged. “However, you do get out of school much quicker, and you don’t have the mounds of student loans.”
If a young person wants to aim for a career as a PCP, good grades are a must. In 2008, undergraduate students applying for and enrolling in medical schools in the United States had a mean grade point average of 3.4 in science classes and 3.63 in non-science classes, according to the AAMC. Students are also required to take the Medical College Admission Test (MCAT), which scores aptitude in physical sciences, biological sciences and verbal reasoning using a scale of 1 to 15. The average score of applicants who are accepted and enroll in medical school is about a 10 in each section, according to the AAMC.
A pre-med major is not a prerequisite for medical school, Driggers said, giving aspiring physicians more choices of where they go to college as undergraduates. She suggests those who are interested in becoming doctors aim for a bachelor of science degree in biology, for instance.
“The minimum training and education is 11 years,” Driggers said. That includes four years as an undergraduate, four years in medical school and three years of residency, where new doctors work under the supervision of seasoned physicians. Specialists typically take on an additional two years or more of training and education.
“Cardio surgeons are 40 by the time they get out of school and training,” Driggers said. “You have to really want to do it, that’s for sure.”
For students conent with becoming PCPs, however, the payback is ample, Rich said.
“Be prepared for work,” he said. “Be prepared to be well-trained to confront anything. But also be prepared to be rewarded emotionally for a job well done.”
The emotional rewards come from the hands-on nature of primary-care work, and the financial rewards are more than respectable, Adler said.
“--Low-tech and high-touch’ is the corny phrase people use,” he said. “You have to want to have that interpersonal relationship with the patients. That has to be one of the major goals of what you want to do with your career. It certainly provides a very decent income. You’re not gonna get rich if you’re just doing regular primary care, but it’s certainly better than (what) most people in this country make.”
Contact Eddie Huffman at 373-7335 or eddie.huffman@news-record.com.
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North Carolina Medical Schools
Wake Forest University School of Medicine medicine.www.wfu.edu
Duke University School of Medicine www.medschool.duke.edu
The Brody School of Medicine, East Carolina University www.ecu.edu/med
UNC School of Medicine (Chapel Hill) www.med.unc.edu
