Letters to the Editor
To the Editor:
Although Jolly et al1 found that the steady decline in medical trainees’ interest in primary care careers may be leveling off, it is estimated that by 2020, a shortage of about 46,000 primary care physicians will exist.2 Today’s primary care practice is characterized less by actually caring for patients and more by an endless stream of administrative tasks—filling out forms and answering phone calls. Medical students know very well that this environment has created a generation of overworked physicians with high levels of burnout, loss of enthusiasm, and a decreased sense of accomplishment,3 and I believe that many trainees have been avoiding primary care careers for these reasons. To improve primary care’s image we must increase the primary care workforce so that the burden is less for each physician.
Primary care training must change to keep up with the changing landscape of primary care practice. In very simple terms, this might be accomplished by making primary care training more practical—two years of college, three years of medical school with only limited basic science instruction, and three years of residency in community care centers, not hospitals. This approach would put more primary care physicians into the workforce faster. With more physicians seeing patients, the primary care workload would decrease collectively, lessening burnout and increasing job satisfaction. With the promise of less drudgery, more students would be attracted to primary care careers.
Another way to ease the burden on primary care physicians is to allow advanced practice registered nurses (APRNs) to provide some primary care services. Although this suggestion is controversial, APRNs have great potential to make the lives of primary care physicians more manageable and to make primary care services more available. This takes on more importance than ever before because the Affordable Care Act will greatly increase the number of individuals seeking primary care services. APRNs are endorsed by the Institute of Medicine as qualified to practice independently within the limits of their education and training.4 APRNs already are practicing independently in 16 states.5
To increase interest in primary care careers, we must first make these careers more manageable for those already in them. Doing so may require drastic measures, such as changing primary care education and allowing APRNs to provide more primary care services, but the future of the primary care workforce and patient safety are at stake. It is impossible for these already-overworked physicians to work safely if they work any harder.
Edward Joseph Volpintesta, MD
President, Bethel Medical Group, Bethel, Connecticut; firstname.lastname@example.org.
1. Jolly P, Erikson C, Garrison G. U.S. graduate medical education and physician specialty choice. Acad Med. 2013;88:468–474
3. . MedEd Update. Match results highlight growing shortage of residency slots. April 2013
4. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. 2011 Washington, DC: National Academies Press