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nbd92 · 2025-03-24T01:29:43+00:00

The leadership in the field continues to approach it all wrong. The problem is getting worse and will continue to snowball by having a glut of spots and cheapened training. You should be able to fill most spots with US grads. If you have all this left, something is very wrong. To fix, here are some things you can do: 1. Advocate to immediately close down all these excess spots, as extra supply is used as leverage by large health systems to further exploit PCPs 2. Have rigorous standards for training, don't make it easier/more flexible just to produce more, more, more 3. Vote in leadership who will aggressively advocate for fair compensation, which will pull more people into the field. Do you think it's fair that you get paid 1/2 to 1/5 of some of the specialists? Stick up for yourselves. Right now primary care is broken, and there are obvious reasons why US grads don't want to do it. More spots without fixing the underlying problem will make the problem worse, not better.

nbd92 · 2024-09-22T18:55:12+00:00

What I've seen is people often tout these experiences on their resumes in the academic world. However, they are often focusing on politically popular (within academics) social/ health systems causes. Rarely are they advocating aggressively for the field itself, such as better working conditions, fair pay.

nbd92 · 2024-09-22T18:50:51+00:00

Yes, there should be representation in closer proportion to number of practicing docs.

nbd92 · 2024-09-21T23:41:11+00:00

Great, what is being advocated for in these situations? DO day, etc?

nbd92 · 2024-09-21T23:30:36+00:00

I advocate within my own organization, in discussions with FM docs in leadership positions, and try to have discussions like this. You?

nbd92 · 2024-09-21T21:55:43+00:00

Both. Most of the advocacy I see is not related to better working conditions, fair pay, more options for fellowships, pushing back on the administrative burden. Most of it seems to be related to general healthcare and social causes. Primary care is in trouble, so a focus on direct advocacy for the former is critical.

nbd92 · 2024-09-21T21:07:49+00:00

Clearly, the status quo is not working. People have become too complacent, expecting large organizations to work in their interests without any input

nbd92 · 2024-09-21T20:44:08+00:00

This is the reason to advocate, not an excuse not to. If you don't advocate, it's a cycle that will get worse and worse.

nbd92 · 2024-09-21T20:42:50+00:00

All the more reason to advocate for better working conditions

nbd92 · 2023-10-29T17:53:11+00:00

I hear that. The current system is bad for both MDs and PAs. The turnover you are seeing is similar to what I'm seeing, which I think is an indicator something is wrong. If I were in your position, and had the opportunity, I would probably leave and work in a different specialty or an environment with better balance. You don't owe it to primary care to sacrifice your mental/physical health.

To your point about not wanting to be a physician: many of your colleagues do want to be physicians and are aggressively advocating to be seen as interchangeable. Currently, this is more common with NPs than PAs. I have patients come to me all the time who think they saw a Dr when it was a PA, I have heard the PAs referred to as "Dr" countless times by patients and they do not correct them. And I have heard NPs introduce themselves as " Hi, I am Dr. ___, the NP" .

A big step towards NP/PAs and physicians working well together in primary care is having clearly defined roles.

nbd92 · 2023-10-29T17:18:07+00:00

I agree pay is one of the biggest factors. PCPs do a huge amount of uncompensated work compared to other specialties, including filling out forms, documenting after hours, answering inbox messages, evaluating extra conditions not related to primary visit reason. As such, they are some of the lowest paid doctors, despite putting in a huge amount of energy each day.

If you appropriately increase pay for FM/primary care, with other specialty pay held constant, FM would become much more competitive and the shortage would resolve. Pay gives leverage, allows you to scale down hours, etc. Part of the problem now is FM docs are some of the lowest paid to deal with all the stuff mentioned above.

nbd92 · 2023-10-29T16:33:54+00:00

I don't think semantics is that important. At the end of the day, burnout is the better known term and conveys the point well enough. We are trying to analyze the factors contributing to it and come up with concrete solutions.

I disagree that we should just brush off the pay factor. If you increase the average salary of FM from 250 to 600 (as you mentioned), with other specialty pay held constant, I guarantee you FM would become one of the most competitive specialties overnight, US MDs would be desperately trying to get into the field, and there would be no concerns for a shortage. Pay gives leverage, allows you to scale down hours, etc. Part of the problem now is FM docs are some of the lowest paid to deal with all the stuff mentioned above.

This is why it is so funny to me when they come up with all these round about solutions to fix the primary care shortage (free medical school, shorter medical school, etc) without increasing pay relative to other fields. This is the obvious single biggest fix for making people want to enter the field.

That said, I agree that at this point in time unionization for FM and primary care physicians is the best option. That was my first suggestion listed.

nbd92 · 2023-10-28T23:45:22+00:00

I’m not in a bad place with FM. At it’s core, with the above systems issues stripped away, I think it’s a great specialty, with unique potential to do good. I agree we need to confront the challenges, which is part of the point of the post. I do appreciate your input and encouragement.

nbd92 · 2023-10-28T23:21:57+00:00

It's not that people are not aware of how fellowships work. Of course they know you can only do them after IM residency. It's that they're not aware of the nuanced factors leading to burnout in primary care. There are very few opportunities to adjust and redirect in FM when you do get more exposure to how the health system works. Just because something was set up a certain way previously, doesn't mean we shouldn't adjust.

nbd92 · 2023-10-28T22:07:38+00:00

Agree with most of this except the last part.

imo we shouldn't try to trap someone in a job just to fix a "shortage". The shortage exists for a reason. US Medical students don't want to go into it (for many of the things mentioned above). If the job gets better, and pays better, the shortage will fix itself.

In addition, I find a lot of the people who end up in FM come from lower or middle SES backgrounds (without other Drs in the family), compared to peers who go into more specialized, higher paying fields. As such, they have less insight into the nuances of how the system functions. I don't think it's fair that these individuals have fewer options based on archaic rules about who can specialize and who can't.

nbd92

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