Family Medicine and Primary Care: Challenges Mount, But Solutions Exist
I
n the 1969 feature film Butch Cassidy and the Sundance Kid, our heroes face an impossible choice: to either be captured by the pursuing posse, or jump off a cliff into a raging river. An embarrassed Sundance at first declined to jump, confessing he couldn’t swim. Butch chuckled and assured him it didn’t matter; the fall would most likely kill them both. Similarly, difficult choices face today’s primary care providers. They must either: spend long hours navigating the myriad of escalating requirements of the healthcare industry (payers, regulators, EHR) to fulfill a myriad of escalating requirements, or work tirelessly to maintain a delicate balance of professional and home life. And for most, neither is likely to happen. Primary care systems nationwide are in crisis. As systems rapidly adopt changes to their care models, providers are put at risk. They are expected to respond to rapid and often haphazard implementations of electronic health record systems, worsening reimbursement, and an increasing demand for quality measure reporting. These, and many other factors, contribute to provider burnout that has becoming increasingly common.1 As even more time is needed to keep up with the demands of the EHR and other administrative tasks, less time is available to attend to the needs of patients. Frustrated Providers
Providers spend increasing amounts of their time outside of clinic hours corresponding with patients via email, Epic
MyChart, and text messages. This time is usually non-reimbursable but takes its toll on providers available time. They are also expected to increase productivity as reimbursement lags, and commonly see their professional life infringing on home life as “pajama time” — a term used to describe EHR and other work done at home — an average of 86 minutes of additional time per day — that could not be fit into the clinic day.2 Current practices such as limited clinic visit lengths and productivity needs force a lessening of connections between providers and their patients, connections that providers often cite as the most enjoyable part of their practice. While attempting to balance work and home and lessen the effects of burnout seen in the majority of primary care providers, many choose to work other than full-time as a career choice.
their specialty focus based on their own unique passion and interest. They were often influenced by faculty mentors or those practicing in specialties that the student might have an interest in pursuing. Students might come to family medicine and other primary care specialties with an altruistic view of the world or as a way to serve their communities. In our residency program, we look to acquaint medical students with Family Medicine as a specialty that provides continuing and comprehensive care for individuals and families, seeing the relations with patients as a special and trusted bond. But it is increasingly difficult to teach learners the joy of practice while at the same time acknowledging the difficulty parsing time among numerous priorities. As new providers become familiar with the workload required to care for their patients, their enthusiasm wanes. They are more often seeing primary care specialties as less desirable as they recognize the increasing level of work expectations (both in hours and in intensity) that will be placed upon both them and their families as they start out their careers. Debt as New Focus
Specialty decisions are also often based on future compensation rather than personal passion. As the level of debt (medical school tuition and living costs) that medical students incur rises, loan repayment becomes a significant influence on specialty choices. The increasing debt load that many residents carry further dampens their
Future Career Choices Affected By Jerry Potts, MD
MetroDoctors
Traditionally, medical students chose
The Journal of the Twin Cities Medical Society
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March/April 2020
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