As a general internal medicine physician in practice for over 35 years who is cautiously optimistic about the future of primary care, I’m encouraged by the increased attention on the shortage of primary care doctors. Legislators are discussing opening a second medical school in Rhode Island ( “Panel mulls medical school at URI,” News, Sept. 3 ). Other efforts include reducing educational debt, a deterrent to choosing a primary care career.
Much less is being said about what is the most significant threat to primary care. To paraphrase a quote from political consultant James Carville: “It’s the job, stupid.”
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Here are a few examples: If a patient can’t work for a week due to illness, a one-paragraph doctor’s note is no longer enough, because employers require a six-page form. I can’t order a walker for a patient who just had a stroke without going three rounds with the device company that wants records and additional documentation even though the need is obvious. To order an MRI, I first have to deal with the insurer’s “1-800-MAY I” line for approval. I work with a sophisticated electronic record that should make me more efficient, but too many clicks and keystrokes slow me down.