Changing how primary care doctors are trained

Letter publilshed in Academic Medicine




May 6, 2011
Academic Medicine
Letter to Editor


Shortening the duration of training for primary care physicians is an idea whose time
has come (1). But there are many who will dispute changing the traditional pathway.

In 2009 I had commented on reshaping the primary care curriculum by shortening the training period from eleven to about eight years and by tailoring the basic science courses to more accurately reflect what primary care doctors actually need. (2) My suggestions were summarily and sharply repudiated because my colleagues in primary care believed that they would lead to inferiorly trained physicians. (3)

Unfortunately, many of our leaders in medicine have failed to understand how greatly the role of the primary care physician has changed over the past few decades. The coordinating function of primary care physicians has become almost as great as its medical care function. Because of the time spent on coordinating patients’ health care needs, primary care doctors are spending less time treating their sicker patients, referring them, instead, to specialists for care.

Thus, taking their “new” role into account, good primary care doctors could be produced without the intense exposure to the basic sciences and hospital medicine that exist today. To some this may seem not only heretical but naïve. But the daily routines of many primary care doctors, if studied, will show that less science and more social and coordinating skills will be needed if primary care is to survive.

(1) Dorsey ER, Nicholson S, Frist WH. Commentary: improving the supply and
distribution of primary care physicians. Acad Med. 2011; 86:541-543.

(2) Volpintesta EJ. An immodest proposal to solve the primary-care physician shortage.
Conn Med. 2009; 73:56-64.

(3) Mueller K, Gates PJ, Viereg K. Re: An immodest proposal to solve the primary-care
physician shortage. Conn Med. 2009; 73: 477-478.

Edward J. Volpintesta MD