Opinion

The Great Debate

How to recruit more primary care physicians — for the VA and nationwide

A patient has her knee examined by Dr. Narang at University of Chicago Medicine Urgent Care Clinic in Chicago

“Can I give you a hug?” a patient recently asked me, just before breaking into tears and wrapping her arms around me in gratitude.

Hugs weren’t on my list of pros and cons when I chose to become a primary care physician, but they sustained me through some tough years. I am devoted to my patients and my profession. But, like many colleagues, I wonder whether I would choose primary care now if I had to choose again.

Primary care physicians have a high risk of burnout. My colleagues continually announce early retirement, conversion to part-time, and changes of profession.

Compounding the problem, too few physicians are entering our field to meet society’s needs. The situation is worse than studies suggest. Some studies count all internal medicine training as “primary care,” even though the majority of medicine trainees will subspecialize.

The result? Access to primary care has been a national problem for years. Recent attention has focused on access for military veterans, but access has been just as bad — if not worse — for many rural and lower socioeconomic populations. Even in otherwise well-served areas, someone seeking a primary care physician may have few to no options, with visit delays lasting months.

To help injured veterans, bring in private sector help

VA BACKLOG

In all the brouhaha about the Veterans Administration — the alleged misconduct and malpractice in Arizona, and the ensuing calls for the head of Secretary Eric Shinseki — it is crucial that the issue not be treated solely as a referendum on Shinseki, and on the Obama administration generally.

The VA system is far too reluctant to ask for help from the private sector in caring for the hundreds of thousands suffering from the signature injuries of 21st century war: post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI).

This is ironic, since it has been increasingly successful in getting veterans themselves to seek help with these challenges — which used to be so stigmatized that they often preferred to hide or ignore them.

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