Primary Care vs. Specialists

Very few people will argue against the notion that our healthcare system is in shambles; however, even fewer people have a legitimate plan for resolving the problem. Yesterday afternoon, two Baylor Med MD/MBA students presented for the last health policy elective session. They provided their insight as to how focusing on primary care is the solution.

Primary care has never crossed my mind as a career possibility as I’ve been set on neurosurgery for quite some time. Yet, surprisingly, this inclination towards specialty residencies is shared by the overwhelming majority of my class. Compared to previous years, the number of residents in primary care is gradually dwindling. The New York Times published a fantastic article addressing this very issue which I highly recommend.

Now let’s consider a hypothetical scenario. One morning, you wake up with unbearable pain localized to your upper left abdominal quadrant (stomach region). You’ve got two logical choices: visit a gastroenterologist (specialist) or your regular physician (primary care). You end up choosing the gastroenterologist because, after all, they have been trained to deal with abdominal symptoms for years. After a plethora of expensive tests, you’re diagnosed with a mild case of stomach poisoning. What if the primary care physician could have told you this same diagnosis for less than half the cost?

A few observations can be derived from this:

  • The specialist had to take time to examine a relatively simple case.
  • The patient (and insurance companies) had to spend more than required.
  • The primary care physician could have made this diagnosis… probably with less time spent scheduling an appointment.

An interesting proposition made during the presentation was using primary care physicians (PCPs) as a buffer between patients and specialists. In other words, a patient would always present to a PCP and then, if necessary, be referred to a specialist.

This suggestion implies that without increased PCPs, the current generation will be working extended hours to meet the increased patient inflow. At this point, an inevitable question must be brought up – how do we adjust physician salaries? The two students argued to increase PCP salaries (currently, one of the lowest-paid physician salaries) while simultaneously decreasing specialist salaries. I’m under the impression that some specialists wouldn’t have been specialists if it wasn’t for the cozy paycheck, but we have to consider several factors in any case.

  • Specialists receive more training (and accumulate more debt)
  • Specialists tend to deal with more risky cases (higher malpractice)
  • Both specialists and PCPs tend to work roughly the same number of hours

Reducing the compensatory gap between specialists and PCPs is a touchy subject indeed, but what better incentive to attract aspiring medical students towards primary care than an increased salary? Moreover, why not focus on primary care physicians to lower healthcare costs from the get-go – the patient coming in for treatment?

I really have no fair argument for or against this, but I thought it was an interesting perspective which I had never thought about before. Hence, a blog post. 🙂

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  1. i read that article in times! (i subcribe to them). haha. anyway, more pcps is a plus. more money for pcps is a plus too. i think it’s possible to have more pcps and have them make more money and stil have a good amount of specialists that have the same salary (which is more b/c of what they have to deal with). there’s always a need to both.

    • We definitely need both, but unfortunately, money makes the world go around. With a finite amount of money and increasing demand for physicians, healthcare is shaping up to be a tug-of-war until we can implement a real change.


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