OPINION
primary care medicine . This administrative vision , equating APRN care to that of trained physician care is not only dangerous to quality of care but further denigrates the critically important field of front-line , primary care medicine . Dr . Barry , in her timely op-ed piece , acknowledges the elephant in the room : the current clinical educational structure for APRN ’ s does not allow “ the chance to learn to think like a doctor , to examine as thoroughly as a doctor , and thus to develop a differential diagnosis as comprehensive as a doctor ’ s .” Collaboration is a model , one that should not generate absolute opposition . However , until the clinical education of APRN ’ s deepens , be it Dr . Barry ’ s model or not , and when the majority of urgent care center notes I read no longer end with an unnecessary antibiotic and steroid dose pack , then Dr . Opelka can attempt to realize his “ vision .”
So , the perception of primary care by my subspecialist and surgical colleagues has been boiled down to days of thankless cognitive and physical labor to care for the snottiest and most mucous filled among us , better achieved with lower compensated APRN ’ s . Why , pray tell , would recruitment to primary care medicine ever be a problem ?
The problem of perception , though , is certainly not restricted to those in post-residency practice . More recently , while volunteering as a representative for primary care at the Specialty Speed Networking event at the medical school , I had one student sit down at my table , announcing a plan for a career in general surgery . After the announcements of career plans of the other students in the small group , this particular surgery-bound student abandoned any attention to the conversation at hand and pivoted to typing on a smartphone without even a hint of effort at attentional oscillation , the skill so perfected by our friends in GenZ . I challenged this student in front of the other gathered classmates at the table and suggested this student “ better be taking notes .” Our brief verbal tussle resulted in the abandonment of the aforementioned smartphone and the diversion of this particular student ’ s gaze to the ceiling for the remaining nine minutes of my discussion with the small group . Sadly , the reputation of primary care medicine had preceded me and , as noted in Dr . James ’ article , the reputation remains , like it or not .
So , whatever are we to do ? Well , challenging the current culture of perception around primary care starts with simply asserting reality .
Primary care practice , to be quite clear , is not just constituted of days filled with coughs and colds , nor is it comprised of an endless cycle of “ follow-ups for hypertension and diabetes .” Truly anything and everything under the sun can and does present in the primary care office . The challenge is being alert , educated and attuned enough to pick it all up and know what to do with
OPINION it . Precisely in this challenge is where primary care is a thankful field . Diagnosing and treating illness , or guiding the patient on an informed path for specialist care , makes all the difference in the reality of outcomes and the patient ’ s perception of their care .
The opportunity to develop a robust and enduring practice is ubiquitous in primary care . As a practicing internist , there does always seem to be far more of them than there is of me . However , in our current reality of patient struggles to find a primary care doctor who has room to accept a new patient and doesn ’ t charge them an annual fee to do so , primary care medicine might just be the most thankful field in medicine . Patients routinely offer thanks just simply for being their doctor in a world where few are available or willing .
The choice to practice general internal medicine as a career is , just that , a choice . The notion that a decision to choose primary care is a necessity borne of an absence of academic fortitude to win a fellowship spot is a misconception . On the contrary , primary care allows a physician to dip fingers and toes ( and sometimes a cannonball ) into the waters of all the medicine subspecialties and provides a veritable lifetime of learning opportunities , appealing to the curious among us . Indeed , it allows one to be the smartest guy ( or gal ) in the room , if one so chooses to take the challenge . If we were doing it right in American medicine , this is how we would be presenting a career as an internist , family physician or med peds specialist . We would not be lamenting , in error , the thanklessness of the job . We would demand the primary care physician to be the smartest in the room , not asking about the flavor of sniffles most prevalent in the office on a cloudy mid-winter day .
The reputation of primary care medicine is bruised and battered , to the detriment of medical practice and the health of our population . The job of changing the culture lies with all of our specialist clinicians , our administrators and with our primary care clinicians themselves . Practicing with a sullied reputation is not always pleasant , but primary care clinicians are not the first , and will not be the last , to push through this adversity . In this , I am reminded of lyrics from one of my daughter ’ s favorite musical artists , Maren Morris : “ Say what you want about me , your words are gasoline on my fire . You can hate me , underestimate me . Do what you do cause what you do don ’ t phase me . Just when you think I ’ m at the end , any second I ’ ma catch my second wind .”
Dr . Kolter is a practicing internist with Baptist Health .
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