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 pres-
tige, 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, pri-
mary care is currently available at offices
where nurse practitioners, physician assis-
tants, or other similar personnel work under
the supervision of a physician. Their mes-
sage 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.
MEDICAL LITIGATION CRISIS
The technological revolution in medicine, which
has dramatically increased life
expectancy, has raised patient expectations, in
some cases unrealistically, resulting in an
explosion of malpractice litigation. This in
turn has caused insurance premiums to rise
to such an extent as to motivate some doctors
to curtail or even completely give up their
practices. Others have taken up "defensive"
medicine, which can result in overtesting
and consequently contributes to the alarming
increase in health care costs.
An unfortunate side effect of "litigation
fever" has been a decrease in the production
of vaccines because of a fear of lawsuits
arising from adverse reactions. Pharmaceutical
companies apparently prefer to give up this
aspect of their business rather than risk the
cost of litigation.
CYBERMEDICINE
The Internet is a conglomerate of computer
networks that encircles the world. As of a
few years ago there were upwards of 50,000
networks with about 10 million computers
serving approximately 150 million users. The
Internet or "information superhighway" is
a spin-off from a project that was initiated in
1969 linking the computers of the govern-
ment's military research centers to protect
data in the event of a nuclear attack.
The public can access the Internet directly
through universities, scientific organiza-
tions, and public libraries. The Internet is
popular and busy because, for the most part, it
is basically free. Your university or medical
school is most likely to have an account and
be online.
Using your own home computer you need a modem
to access the Internet over your
phone line and a communications program to
communicate with the computer at the
other end of the line. Using a university
account has a major disadvantage for it requires
technical skill to work through a maze without
the help of a customer service depart-
ment. Time has to be invested to learn how to
proceed and find what you are looking
for; nevertheless, there is a substantial
savings using a university account rather than a
commercial one.
On the other hand, if you feel overwhelmed by
such chores you have the option of
gaining Internet access through a commercial
company (such as America Online,
Compuserve, Prodigy, etc.). You may also use an
ISP (Internet Service Provider), which is
a company that provides direct access to the
Internet for a low monthly fee. It is important
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