Letter published in Academic Medicine
December 2011 - Volume 86 - Issue 12 - p 1484
Letters to the Editor
Ensuring the Future of Primary Care
Volpintesta, Edward Joseph MD
To the Editor:
Shortening the duration of training for primary care physicians, as suggested by Dorsey and colleagues,1 is an idea whose time has come. But there are many who will dispute changing the traditional pathway.
In 2009, I commented on reshaping the primary care curriculum by shortening the training period from 11 to about 8 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 my approach 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, capable primary care doctors in their “new” role could be trained 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.
Edward Joseph Volpintesta, MD
1 Dorsey ER, Nicholson S, Frist WH. Commentary: Improving the supply and distribution of primary care physicians. Acad Med. 2011;86:541–543. http://journals.lww.com/academicmedicine/Fulltext/2011/05000/Commentary__Improving_the_Supply_and_Distribution.6.aspx. Accessed July 22, 2011.
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;73:477–478e