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Thursday, August 14, 2008

How many patients can you see.

The family medicine group I am with have 2 locations and most days 1 doctor is at each location but on Thursdays they both work together at their busier location. Today I had double the patients and double the fun. From the minute I entered the office in the morning  until late into the evening it was nonstop exams. I saw 40+ patients today. The whole day seems like a blur. 

It is unfortunate that primary care doctors are often forced to see large numbers of patients to keep their doors open. Given falling reimbursement, payment defaulting, and increasing costs it has become difficult for primary care physicians to make enough money to sustain the costs of running their practice. Today's medical students are coming out of medical school with more school debt than any other generation. It is well know amongst students that primary care dose not pay well, so as you can imagine, it is becoming harder and harder for to recruit / convince medical students to choose primary care as a profession. Unfortunately there are not any real remedies to this is the foreseeable future. 

I have been speaking with some of the other students on the family medicine rotation and they are all having to see tons of patients and only allowed to spend limited amounts of time with each patient. This scenario creates angry patients and frustrated doctors and sets up an environment for less than optimal care. I think most doctors are able to deliver sufficient care with these packed schedules but they could certainly deliver a much better standard of care with more time allowed for each patient. 

Even though there are many things I find appealing about family medicine, I do not think I am up for the torture that these doctors are forced to deal with as primary care physicians. Way too many hours of work for way too little income (often a negative balance sheet), for too much liability. 

The family doctors in more rural areas are able to do a little better because often these smaller towns will subsidize the pay in order to get a doctor to their town. The down side of the rural medicine is that often you are the only doctor which means you are never off, you are on call 24/7. The other problem is having to raise a family in the middle of nowhere could also have some unique challenges. 

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