A SECOND OPINION
A Second Opinion welcomes the freely written articles of our diverse membership , whether these conform to the opinions of our publishers , our Editorial Board or other groups . However , we ask that opinions remain collegial and respectful . The Editorial Board and Oversight Committee reserve the right to choose what is published . We invite you to share your thoughts with us , and to respond to others , at editor @ glms . org . Publication does not represent endorsement by Louisville Medicine or GLMS . Let us hear from you !
In Responsum by JOHN DAVID KOLTER , MD
The December edition of Louisville Medicine , in articles by both Dr . James and Dr . Barry , dedicated much needed space to the current state of primary care . The articles were notable for highlighting the perceived decline in the field , whether it be in numbers of practicing clinicians , erroneous equilibration of physician care to that of advanced practice nurses ( APRN ) or dwindling prestige . As a practicing internist , all feel palpable and worthy of concern and , well , maybe a bit of a rejoinder . My response is grounded in my experience and , clearly , primary care has a problem of perception . Perception , though , is not reality , and challenging the cultural perception around primary care would start to refocus the lens with which primary care is viewed .
I remain inspired by those who trained me as a resident , now well over a decade ago , who demonstrated the reward of the remarkable breadth of knowledge one can obtain by studying and practicing across the medical disciplines . However , concurrent with my time in training , financial and insurance realities were driving primary care clinicians out of private practice with a deleterious spill-over effect on the perception of the field as a whole .
This problem of perception became evident from nearly the moment I began practicing . I recall vividly , very early in my career while serving as an At-Large Board Member for GLMS , an example that , to my experience , would serve as a harbinger . I sat in an early morning Board meeting whose direction , for reasons I cannot recall , had turned to a discussion of primary care . A well-respected specialist , taking his turn opining on the state of primary care , insisted that support should be readily demonstrated for primary care colleagues “ because it is such a thankless job .”
This public assertion of perception of primary care medicine , by someone who has never practiced it ( and recorded for posterity in the board minutes ), was a cruel distortion of reality . Unsurprisingly , no one objected , including myself . Sensing an immediate response of anger , I trusted not my response in that moment to be printable in said minutes . I was made aware of the glaring , and growing , acceptance of a perception in medical circles , including the large one in which I sat that morning , that primary care would be the location where the proverbial s--- runneth downhill . I admit , this affront of ignorance by arrogance I have still not quite forgiven .
Not long after this midwinter board meeting , I sat down to lunch in the doctors ’ lounge , across the table from a surgical subspecialist , who drearily asked , “ So , what kind of colds are you seeing in the office these days ?” Relatively new to practice , compared to a primary care colleague , who had just sat down next to me , I found this question to be rather a benign , if uninteresting , conversation starter ( though this says nothing , after a full morning of patients , of my relative lack of desire to start a lunchtime conversation ). My colleague , more rankled than I by this question , mumbled under her breath , “ Yeah , and every other f------ diagnosis known to man .” I was taken aback , certainly not by the use of an expletive , but at my colleague ’ s fiery response to a question that I had found , at first pass , to be positively dull . Fast forward a good decade , after having been asked that question more times now than I care to count , I am likely to give the same response as my colleague who had wised up to the undertone and insinuation in the question years earlier .
More recently , I read the December edition of Louisville Medicine , with absolutely no sense of irony , the “ vision ” for primary care put forth to Dr . James by Dr . Frank Opelka , Medical Director of the American College of Surgeons : “ the future of primary care will be the oversight of nurse practitioners .” Dr . Opelka ’ s online bio from the College does not document that he has ever practiced
22 LOUISVILLE MEDICINE OPINION