showing up in their offices . Three months of hospital rotation with medicine , infectious disease and pulmonary teams would go a long , long way towards improving their diagnostic and treatment skills and acumen . There is simply no substitute for seeing actual patients with happening illnesses , taking responsibility for them BUT having that professorial backup all the way . APRN education combined with medical education makes utter sense to me : we have the infrastructure ; we need the imagination and drive to make it happen .
The Economist also points out the long , long road to full qualification as an American doctor : four years of college , four more of med school , up to seven for residency and then , especially in surgery and cardiology , added-on fellowships beyond the standard for super sub-specialties . Someone who dreams of taking out a hot appendix can end up as a pediatric plastic surgeon some eight to ten years removed from college graduation .
And , if you are not yet worried enough , two out of five practicing U . S . doctors will turn 65 by 2033 . Some will retire sooner due to illness or stress , some will die , some will keep working , but : who will be around to take care of everybody , particularly the old ? Geriatric care is not a speedy entity , by definition .
The walls that choke off the supply of U . S . doctors can be breached .
I know , I know , basic science matters , but truly , as a practicing internist I had no use for the Krebs cycle whatsoever . I had to prove my mettle getting straight A ’ s like everybody else , but why ? Why do we still slow the actual learning of medical care by enforcing years of scientific prerequisites that are not immediately relevant to primary care , when what we need most of all are “ take care of regular people ” doctors ?
More than 40 U . S . schools offer combined BS / MD degree programs , most of them six-year , although Brown University ’ s , one of the first , lasts eight years . Still , there is no guarantee , as students move up in medical exposure , that they will want to do primary care . They may become entranced with something fancier along the way .
What I believe we need – which should happen before we run out of primary care internists altogether – is a special , dedicated primary care track : over seven years , you go to two years undergrad in the sciences and humanities , then two years of medical school , one preclinical and one clinical ( medicine , surgery , peds or OB-GYN , GI , ER , infectious disease , orthopedics , pulmonology , cardiology , neurology , nephrology , oncology ). Then you follow three years of medical or pediatric or med-peds residency , which includes hospital months alternating with office months : you cannot learn internal medicine just in the office . You have got to see sick people and you need several months at least of oncology , since those patients suffer in ways that you must learn to recognize and help . They have lots of infections , lots of electrolyte issues , lots of neuro issues , anemias , lots of chest issues : you learn a ton of internal medicine from cancer patients .
The kicker is : you only get into this program as a dedicated primary care person . You get special government funding that will allow you to have your loans forgiven ONLY after practicing primary care , in any sort of office , for a full 10 years : the government will absorb the cost after 10 years of your work . However , you will be required to pay back all loans at a high interest rate if you jump ship at any point to any specialty .
We ’ ve had the Civilian Conservation Corps and the Peace Corps and what we need is the Civilian Primary Care Corps . Sign up as a college freshman , end up as a community doc with an established practice - and all your educational cost will go away . Ideally you will get a stipend as you go along , you will get special mentors , you will make lifelong friends and you will be caring for fellow citizens who need you and know you . My Corps will be diverse and will understand working parents , if I have anything to do with its design .
Thusly we will not run out of primary care doctors : praise the Lord and pass the drug-rep pizza .
Dr . Barry is an internist and Associate Professor of Medicine ( Gratis Faculty ) at the University of Louisville School of Medicine , currently retired and mulling her next moves .
SECOND OPINION