So, if you're in healthcare and living under a rock, you might not be aware of this, but primary care in the US is in a state of "crisis" right now. Fewer and fewer medical students are choosing primary care and opting for more-lucrative specialties like dermatology, radiology, and anesthesiology. The traditional doctor-patient relationship is doomed, as the ten remaining primary care doctors in the US will be replaced by physician assistants and nurse practitioners.
A solution, at my school among others, has been for doctors to "talk up" and encourage students to go into primary care. It's like sacrificing oneself for the greater good; you are going into a lower-paying but demanding field for the good of the US and your other fellow physicians. If primary care goes, what is next? Psychiatry? Well, that's kind of a spooky field anyway. What about anesthesia, though? Or God forbid, surgery? Nervous laughter.
So it looks like a lot of medical students have taken this call to serve seriously. From the most recent data available, an increasing number of medical students entered primary care this past year for the fourth year in a row. http://www.usatoday.com/story/news/nation/2013/03/15/doctors-medicine-match-residents/1990549/ Despite the hassles involved with primary care, which are very real, a lot of medical students are forfeiting millions of dollars in potential lifetime income to serve on the traditional first line of defense against illness, and prevent encroachment on the field from NPs and PAs. Except... why are NPs and PAs replacing doctors?
PCPs simply do not have enough time to perform their job well. Period. As a 2012 paper notes:
Estimates suggest that a primary care physician would spend 21.7 hours per day to provide all recommended acute, chronic, and preventive care for a panel of 2,500 patients. The average US panel size is about 2,300. http://www.annfammed.org/content/10/5/396.fullSo, really, maybe this crisis could be averted if existing primary care doctors just worked 21.7 hours per day. Or maybe we legitimately need healthcare professionals with enough time to actually take a damn physical exam, let alone a history. Maybe patients appreciate being listened to; I suspect that's a reason NPs outscore physicians with regard to patient satisfaction (http://www.clinicaladvisor.com/nurse-practitioners-outscore-physicians-in-patient-satisfaction-survey/article/206090/).
Maybe doctors need time to help heal their patients. This might not always be true; a broken bone is just a broken bone. (A cigar is sometimes just a cigar!) But what about patients suffering from chronic diseases, like lower back pain, depression, hypertension, or diabetes? Maybe part of their treatment therapy could be a healthcare provider's time... regardless of whether it is a NP, PA or MD.