Shout it from the rooftops: We need primary care physicians!

Debra L. Glasser, M.D.

Photo by Olympia Wedding Photographer | Loewyn Behold Photography

A JOLT OF HEALTH

Primary Care Internal Medicine is dead

My column from May 21, "Primary Care Internal Medicine is Dead"  has gone around the world, as it was republished on July 17 in Medscape. 

Medscape is an online resource for physicians and healthcare professionals worldwide, offering medical news and expert perspectives; essential point-of-care drug and disease information; relevant professional education, and Continuing Medical Education. It is under the umbrella of WebMD.

That column was autobiographical. Based on the feedback I have received, mine is a story shared by many (if not most) seasoned primary care physicians, across this country and the English-speaking world.  

All are grieving the loss of primary care physicians including internists. As a result, everyone suffers. Doctors and nurses shared their own challenges in finding a primary care physician, few have an internist.

Today I want to share the wisdom of those who emailed me in response to the piece; many asked that I do so.  Their words say it best and touch on every relevant issue.

What has been lost since The Golden Age of Medicine

From a retired 77-year-old retired internist:

“… I do remember curbside consults and the feeling in the halls that we were all on a shared mission of exercising our intellectual gifts in service of those almost always very much less fortunate.  There was a culture, which is probably one of the correct modifiers for the soup in which we swam, of excellence.  And of excellence because we were doctors...which meant something somewhat different than it might today in 2024…

"My sense is, Dr. Glasser, that it is the commodification for profit which has done us in.  Hiring our descendants as piece workers, they have…the hospital corporations. But a code of ethics.  Moral bearings.  These suffered over the years of increasing administrative overlays of non-medical humans unaware of our code, our oath.  And... our oath.  Not so much Hippocrates or Maimonides.  More being unequivocally attuned to the shared faith that we were doctors, a very serious life of serving via our intellect.”

From a fellow internist:

“I have a sense of pride when it comes to internal medicine. When we lose this, we are losing diagnosticians and general health strategists and the beautiful rounds and discussions of human health and patients because no one does this better than internists. If we read more about Sir William Osler and how he highlighted the ethics and codes of internists, we will do everything to protect this history and code of doctors and science.”

From a family doctor in Australia:

“Ditto in Australia, Debra."

From an experienced Registered Nurse:

“I'm happy that I was able to experience hands-on care with internists.  They were usually the admitting doctors into hospitals and wrote all the admission orders.  I looked at an internist as the captain of the ship.”

From a clinical developer of orphan drugs to treat rare diseases:

“Primary care and internal medicine physicians… These are the most dedicated and expansively skilled doctors that I have had the privilege to have known, fielding everything from ingrown toenails to cancer.  

"I hope like you do, that we are turning medical treatment around, worldwide, to eliminate medical deserts and encourage and increase the number of young med students into generalists”

From a primary care internal medicine doctor struggling to ‘make it’ in Mississippi:

“That is why I call myself a dinosaur.  Internal Medicine is a dying breed of doctors that used to reign supreme as the ones to go to … when no one else could get things “back on track.”  Now, I fear we are headed for the tar pits to slowly fade away into obscurity. “

40-year solo primary care internal medicine physician in Healdsburg, California:

“I guess we didn’t realize we were albatrosses; we just knew it was great. We were so lucky!”

From a general internist who started practice 14 years before me:

“I started practice in 1970, and I retired in 2010 when I found that I was spending more time with EMRs (electronic medical records) than with patients.  We practiced in the golden age of medicine, but no one wants to do primary care anymore because they pay much more for doing a procedure than figuring out that the patient needs it.”

From a Canadian Critical Care Medicine specialist (internist-hospitalist-intensivist) in Toronto:

“I can only partly relate to the specifics of your story, but I can relate to the experience of watching powerful forces erode and misshape the vital profession I have loved and cherished, to which I have given so very much for so long, and which has given back to me in multiples. “

From a family medicine doctor:

“After 25 years in Family Medicine I am drowning in Medicare rules, HCAP scores, and clicking my ass off all day long. Keep reaching out to the masses. There are more of them than us.”

Two primary care internists of my vintage:

“When I started I went to the hospital, nursing home and office daily. I saw 20-25 patients in the office in 5 hours, finished my day between 6 and 7, happy, with great job satisfaction. When I left I only went to the office, 7AM to 6PM and could see 15 patients, spending 50% of my time on charting. Much less satisfied. Supposedly more efficient (for the insurance company and accountants).”

“The loss of care of patients in the hospital by their primary care physicians was the worst thing that could’ve ever happened.”

A physician wrote about his son, a hospitalist:

“It is a job for him and not a calling, as it was for us. “

From a long-term RN:

“I do understand the statistical reasons for those old-fashioned physicals to be dropped, but the outcome is the loss of real connection with the patient.

"What in the world is a provider?  A primary physician relegated to be called a 'provider' after 12 years of education? I'm fortunate to have the knowledge and fortitude to not settle for less, I prefer doctors.

"I no longer work as an RN, but loved working with new and experienced physicians. We relied on each other, trained, taught skills, shared our knowledge, and covered for each other with trust and respect. Knew our patients. What I see now as a patient is chilling.”

From a cardiologist:

“I think we are missing an important concept which severely affects care. All internal medicine docs who specialize can, should, and must be made/ encouraged/incentivized to practice primary care.”

In the meantime, what can you do?

I will investigate this further in the next column and in the next chapter of this story: What can be done to restore primary care? It is the foundation of healthcare.  

Suggestions:

• “Shout it out on the rooftops (digitally and otherwise) if you can – “You never know where it might hit home and make some impact, “from a Ph.D. psychologist.
• The internet is a powerful force. Think of the impact of social media.
• Vote.
• Advocate for yourself and make waves if you must.
• Consider asking your specialist to take you on as your primary doctor. Fat chance they will say yes but if enough of their patients hound them, you never know, maybe they will. At least until the primary care shortage is replenished. It might actually enrich their day!
• Ask your primary care doctor to take care of most of your needs. I did:

Recently, my family practice doctor referred me to gynecology for a non-complex issue.  Getting an appointment with a gynecologist (since mine retired) is next to impossible in Olympia. I am certain my doctor can manage this. Someone tied her hands. Maybe my insistence (and yours for similar or other non-specialty necessities) can make a difference. Heck, I practiced routine gynecology day in and day out as an internist. Family practitioners are trained to practice gynecology including delivering babies!

There are more of you patients than us docs. Your ‘shouting’ (asking, persistence, and self-advocacy), virtual or reality, can make a difference. You never who'll listen.

Debra L. Glasser, M.D., is a retired internal medicine physician in Olympia. Got a question for her? Write drdebra@theJOLTnews.com