The Lost Glory Days of General Practice, and a Vision of it's Resurrection

I'm on my family medicine rotation right now.  One of my preceptors is ~80 years old, and went through medical school in the 1960s.  He is still sharp as a tack, and quite possibly the most BAMF-ing family practitioner of all time.  He used to do c-sections, hernia repairs, appendectomies, fracture repairs, and get this- emergency burr holes for subdural hematomas (aka neurosurgery).  He stopped ~1997, mostly because he got tired of his morning cases getting bumped constantly for overnight emergencies and throwing off his schedule for the rest of the day when he had clinic in the afternoon.  He has since moved out to Palm Springs, where he still sees more patients than any of his fellow physicians in the group, still does all his own trigger finger release surgeries and SCC/BCC excisions, and still administers the group.  In addition to all this, he is one of the nicest people I've ever met, beloved by his patients.  He truly epitomizes the fading glory days of family medicine, the ideal of the General Practitioner who could truly do it all.

Why Your Doctor Doesn’t Work For You

Many doctors are ambivalent about the Affordable Care Act. This is not due to the primary aims of the bill- after all, more people with health insurance means more paying patients, so what’s not to like? Rather, doctors are worried about the other, less publicized pieces of the bill, and related changes to Medicare and Medicaid that have quietly reshaped medicine- and often not for the better.

Why I'm (Probably) Not Going Into Primary Care

I have to say when I was applying to medical school originally I was interested in primary care.  One of my role models was my aunt, a PCP, whom I worked for as a scribe/medical assistant.  She walked me through her differential diagnosis for each patient and I was hooked at her level of knowledge and thought process.

Why More Pay (Probably) Won't Create More Primary Care Physicians

There have been many, many calls recently to increase Primacy Care Physician(PCP) pay, and decrease that of Specialists. I'll link to just one example here. (The link in question also features some AMA RUC bashing, a topic I've covered before). This is part of a drive to lure more medical school graduates to Primary Care specialties such as Family Medicine and Internal Medicine.

Primary Care vs. Specialist Pay, the RUC, and the News.

The Relative Value Scale Update Committee (RUC) of the American Medical Association (AMA) is back in the news, courtesy of the New York Times.  It's more of the usual story, published by the WSJ less than 4 years ago: specialists are paid too much, primary care physicians are paid too little, and it's all because of an evil committee of doctors who are members of the evil medical trade union group known as the AMA who set payments.  (Full disclosure, I'm a proud member of the AMA).  A good perspective on the debate from Paul Levy, a former non-physician hospital CEO, is here.