OGDEN -- Nearly everyone wants a good primary care physician -- someone who knows them better than anyone else in the medical field and who will provide continuous care throughout their lives.
But the number of medical students going into primary care has been dropping since 1997, and that has many health care providers very concerned.
"We need to redesign primary care, and if we don't, we're going to be in grave danger," said Dr. David Mechanic, a professor of behavioral sciences and director of the Institute for Health, Health Care Policy and Aging Research at Rutgers University.
"This has been a growing concern. All is not well."
Speaking Friday at the annual Ogden Surgical- Medical Society Conference at the Eccles Conference Center, Mechanic said there are several reasons medical students aren't choosing to be the "first-stop doc."
Those reasons include lower pay, higher debt coming out of medical school, less reimbursement, a weak primary care teaching environment in medical school, longer days and an array of administrative headaches.
"Primary care physicians often feel like they're on a treadmill," Mechanic said. "They have to see more patients if they are going to meet their target income but feel they can't spend the time they need."
Not only is this frustrating to doctors, but it also can put the patients in danger as well, Mechanic said.
"People see their primary care physician for many conditions -- many chronic conditions -- such as asthma, diabetes, congestive heart failure," he said.
"There's an amount of safety for the patient when they aren't going to several different doctors for the same condition. The primary care physician can keep patients out of the emergency room. They can keep them from being admitted unnecessarily and can prevent patients from receiving unnecessary tests."
Stephen Bruce, a primary care family physician, agrees.
"We need to get better outcomes while spending less money, and the only way to do that is to develop a system based on a core of primary care providers," Bruce said.
"All countries with financially sustainable and successful health care systems have a core of primary care. As good as we are in certain aspects of health care in this country, we are neither financially sustainable nor successful, in my opinion."
Brent Williams, also a primary care family physician, said he's not surprised that more medical students are opting not to go into his area of medicine. Even his son, a second degree medical student, has chosen not to follow in his father's footsteps.
"It's hard work for the reimbursement that comes with it, and there's a lot of intrusion," Williams said.
"You have to constantly justify why you've made a decision. There's a lot of nonmedical work these days, and that makes it hard to attract medical students."
Both Williams and Bruce said they chose family practice because it's nice to know a little bit about a lot of things.
They said they also like the fact that they know their patients well and have had the opportunity to treat multiple generations.
But today, that's not enough.
"There needs to be a way to compensate the provider for this type of practice, and therein lies the crux of the issue: money. We all need some of it, we all want more of it," Bruce said.
"Yet, I personally feel uncomfortable complaining about my compensation when I am, within society, a highly compensated individual.
"Maybe because people in family practice are generally nice guys, we haven't collectively done enough to demand a fairer system of compensating physicians, so we've been left at the bottom of the ladder."
Mechanic said in order to reorganize primary care medicine and make it more attractive to medical students, several things must be done.
They include allowing the doctor to spend more time following up with patients, fully functional electronic medical records, organized teamwork and collaboration, reimbursement based on performance and not quantity of care, and the development of patient-centered medical homes, a program designed to provide comprehensive primary care while facilitating a partnership between patients and their providers.
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