Physicians and Medicine in the Twenty-first Century

In the course of the past half century, the number of specialists has increased dramatically. At the same time, the number of primary care physicians (general practitioners or family physicians) has declined substantially.

As noted above, primary care is becoming especially important as the health care system is being revamped. Because of the over-abundance of specialists, it is believed that health care is excessively expensive and less focused on prevention. The goal, therefore, is to establish a suitable balance between specialists and primary care physicians. To shift the trend away from specialization, there is a move on to restrict funding for subspecialization and to create incentives for those entering primary care.

Among the attractive features of primary care is the opportunity for treating patients of all ages. Another appealing element for a primary care physician is the wide variety of cases one is able to treat. A third feature is that of providing continuing care and the development of a special bond between the patient and the physician.

A survey of nearly 300 fourth year medical students was conducted to determine what factors played a role in choosing primary care careers. It was found that this group was more likely to be motivated by: (1) the opportunity to provide direct patient care in an ambulatory setting; (2) the fact that there is continuity of care; and (3) the possibility of being involved in the psychological aspects of medical care. Those electing high-tech specialties were more likely to be motivated by a desire for a large income, greater prestige, regular hours, and more leisure and family time. Furthermore, this study indicated that the significant factors involved in the choice did not include any of the following: student age; race; sex; marital status and level of indebtedness; concern about the increasing regulation of medical practice, malpractice, and health manpower reports; or the increasing number of elderly and chronically ill patients.

A developing challenge to primary care, whose impact can't as yet be measured, comes from proponents seeking to offer such care by nonphysician providers. Thus, primary care is currently available at offices where nurse practitioners, physician assistants, or other similar personnel work under the supervision of a physician. Their message to the public and the government is that there are less expensive alternatives available as sources of primary medical service. It remains to be seen how serious a threat this option will prove to be to primary care physicians.