Reader Responses to The Primary Care Crisis

As a family physician who retired over 10 years ago, I read with interest “The Primary Care Crisis.” While I agree with much of what was discussed, I think an important contributor to the shortage of primary care doctors was omitted. That is the active discouragement of this sphere of practice in medical schools in the USA. This was my personal experience in 1972-76 in a new medical school (SUNY Stony Brook) which was ostensibly dedicated to producing primary care doctors. I remember being told by more than one professor that I was ‘too smart to go into family practice.’ A second concern I have about this article is the cited pay discrepancy between specialists and PCPs. While I agree that this is true, and a real concern, it still dismayed me that the average annual salary of $250,000 to $275,000 for PCPs is presented as obviously inadequate.This compares with the average annual salary in the US of $66,622, and early career median salaries for Ivy League graduates with four years of post-undergraduate training of $150,000-$250,000, both according to AI. Lastly, promoting direct primary care as even a component of a solution to the PCP shortage, advocates a model which discriminates against the majority of Americans, who cannot afford the out-of-pocket expenses inherent in this care. A National Health Plan, or Medicare-for-All is not even mentioned, but could provide a partial solution, by cutting overall costs of health care, and thus allowing more funding for primary care initiatives.

I am a family physician who has spent my entire career in Federal Qualified Health Centers (AKA Community Health Centers); First in Washington, D.C. with Health Care for the Homeless, then in Cincinnati, and for the last 21 years at a rural FQHC in Upstate, N.Y. The Primary Care shortage is all the more acute in underserved areas and within that category rural communities are in the most dire circumstances. We employ a number of nurse practitioners and physician assistants, but we simply do not have enough physicians. Since my arrival here, the situation has steadily deteriorated. To address this we have started a Family Medicine Residency. We know that a significant number of physicians stay in their communities when they train in a rural environment and so we are growing our own PCP’s. This is just one strategy but until Primary Care is truly valued by American society and seen as a public good rather than a line item on a balance sheet we will continue to struggle.