If there is one thing consistent about primary care, it's inconsistency. Government regulations involving health care have changed at a historic level. Advancements and theories involving treatment and medicine are moving along at a rapid-fire pace. The days are behind us when a person or family would see one doctor for all their physical ailments.
In a 2011 Journal of the American Medical Association network survey of senior medical students in the United States, only 2 percent expressed interest in practicing primary care, down from 9 percent in 1990. The Association of American Medical Colleges estimates the country was short 29,800 primary care physicians as of 2015, with the number projected to increase to 65,800 by 2025.
Dr. Jennifer Stolin practices family medicine in Goose Creek and is relatively new to the field. A 2011 medical school graduate of the University of Virginia, she said the field is changing.
"Fifty years ago, the majority of physicians were primary care physicians," she said. "Today, that is no longer the case. Even as of this past year, the majority of medical school graduates continue to pursue a specialization outside of primary care."
Primary versus Specialization
According to a 2010 study from the Reuters Archives of Internal Medicine, there is a significant gap between specialists and primary care physicians. The survey of doctors showed that on average, doctors work 53 hours per week and 47 weeks out of the year with an average salary of $187,857.
Specialists were on the highest end of the spectrum, with neurological surgeons and radiation oncology specialists pulling in $132 and $126 per hour, respectively. Medical oncologists, plastic surgeons, immunologists, orthopedic surgeons and dermatologists all made over $100 per hour, while primary care sat at the lowest paid at just over $60 per hour. A 2016 Medscape report showed an almost $100,000 annual pay gap between primary care doctors and specialists.
According to the American Medical Association, primary care physicians work over 10 hours longer per week on average than specialists.
The passage of the Affordable Care Act affected uninsured Americans, but it also affected insured citizens and health care professionals. According to U.S. News & World Report, premiums rose by more than 9 percent across the country, with some states seeing an increase of almost 45 percent.
It is a well-known fact in the medical community that there are certain bureaucratic duties that follow primary care, most notably copious amounts of paperwork. More and more, doctors are having to log in data to computers, taking time away from their personal lives as well as their face-to-face time with patients.
Not only is the doctor-to-patient time ratio eroding, but the choices for providers are as well. In some cases, because agreements have not been reached concerning reimbursement, many insurers are not participating in the ACA exchanges, making for an extra hurdle for both patient and doctor. Luckily for Dr. Stolin, she has the support of a corporate hand.
"In the past few years, government regulations have been released faster than most independent physicians can monitor and implement," she said. "Fortunately, working for a place like Palmetto Primary Care Physicians, we have a corporate structure supporting us to maintain compliance. This has been invaluable."
A sizable benefit for primary care is the stability and security of being under a hospital tent. While specialists are often on their own, primary care physicians can maintain a cozy small-business environment with the big-business assets that come with a hospital. Dr. Stolin shared the experiences of her own practice under PPCP.
"I have been fortunate to benefit from the support of the HCA/Trident Hospital System to help establish my practice while also enjoying the freedom to pursue my own practice style by working with an independent group, Palmetto Primary Care Physicians," she said.
Challenges and Benefits of Primary Care
Being a primary care physician comes with its share of pluses and minuses. Whether it is staying compliant with the Health Insurance Portability and Accountability Act in an ever-changing market, claim denials or collections and deductibles, there seemingly is no down time for physicians. Dr. Stolin lamented the time spent on menial tasks because it takes away from the time she can spend with her patients.
"Challenges in health care, specifically related to documentation and quality measures, have placed an impressive time burden on physicians previously devoted to direct patient care," she said.
The challenges come each day, but so, too, do the rewards. A doctor such as Dr. Stolin, who relies on referrals, relishes the opportunities to interact with, assist and heal patients as a victory each and every time.
"There is such diversity in primary care. In the span of a few hours, you may share in the joy of a new pregnancy, suture up a wound or walk with someone in their darkest hours. I get to spend my career enjoying the relationships that develop over a lifetime," she said.
"The rewards of being a primary care physician come when the computer is off, the documentation is behind me and I am one-on-one with my patients, partnering with them to manage their health. I became a primary care physician to help people, and that part of my job never grows old," Dr. Stolin said.