To Be a Family Doctor, Or Not To Be

Primary care doctors provide essential care

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Over the past year, as the world grappled with the severity and enduring presence of COVID-19, people realized the critical importance of the medical profession and frontline health care workers. Communities continue to rally around their local medical professionals in meaningful ways as they contend with a once-in-a-generation public health event.

The increased attention also has led patients to consider their own health and the key medical practitioner in their lifelong journey of wellness – their family medicine doctor.

According to Stephen Carek, M.D., medical director for the Center for Family Medicine with Prisma Health-Upstate/University of South Carolina Graduate Medical Education in Greenville, primary care doctors are uniquely positioned to lay the groundwork for a healthy lifestyle for their patients.

“The beauty of family medicine is really the amount of interaction you have to impact patients and influence their lives,” Dr. Carek said. “Getting to see patients over a challenging time and having multiple touch points with them over the course of months or years helps to build trust and can allow the doctor to assist with putting the patient on a path to better overall health.”

Dr. Carek said residents often cite this potential for strong therapeutic relationships as one reason they gravitate toward family practice. They also appreciate the challenge of treating a broad range of patients, including children, the elderly, people with multiple diseases, as well as uninsured or underinsured patients and those of lower socioeconomic status.

“Many of them are also attracted to the variety and the broad knowledge and skill set needed in the family practice field,” said Dr. Carek. “These residents may not want to just focus on one specific population or one organ, such as a heart or the lungs.”

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In his position, Dr. Carek has noticed recent growth in the primary care field, with more residents choosing it as their specialty following medical school. He hopes this trend will continue.

“We are seeing more interest in family medicine,” he said. “This year we have eight to 10 residents going into family medicine, which is slightly higher than in years past.”

This may be due in part to the American Academy of Family Physicians’ aggressive goal to encourage 25% of medical students to choose family medicine by 2030. The organization estimates that only 13% of U.S. medical school graduates match into family medicine programs and projects significant workforce shortages over the next decade due to increased patient demand. AAFP launched its 25 x 2030 initiative in August 2018 to begin to address this potential deficiency.

“There’s been a huge push to get more students into family medicine and primary care,” Dr. Carek explained. “We will see the need for family doctors increase greatly as our populations of patients get older. Everyone needs, in my opinion, a primary care doctor they trust and see regularly. I see that as our primary mission – to recruit strong medical professionals and train them to help meet that need.”

While it’s too soon to determine the effect of the COVID-19 pandemic on student interest in the medical field in general and family practice specifically, Dr. Carek speculated that medical school training programs will see an influx of applicants in the coming years.

“It’s still early and I can’t say we’ve seen evidence yet of a COVID-19 application spike,” he said. “But medical school applications are up this year and the pandemic response has given health care a front seat. I think the experiences of the past year may have inspired people to join the profession, and that’s certainly a positive.”

The AAFP’s ambitious recruitment campaign and collateral impacts of COVID-19 may combine to create the perfect storm when it comes to attracting, schooling and training a whole new cadre of young and enthusiastic family medicine doctors.

However, there are still some challenges with which to contend. Chief among them is the availability of residency openings. The AAFP estimates that programs such as the one Dr. Carek oversees will need to more than double the number of family medicine training slots they currently offer. Additionally, the organization advocates for changes in the practice environment, including addressing challenges with electronic health records, performance metrics, insurance prior authorizations and other issues that lead to physician burnout.

Dr. Carek agreed and added that the quick transition to virtual care during the COVID-19 response further strained many family practice doctors who were already experiencing chronic fatigue at work.

“The amount of responsibilities that the primary care doctor has to take on can be very overwhelming,” he said. “There can be a lot of additional burden with administrative work, like phone calls, paperwork and follow-up with insurance companies that takes place outside of the normal nine-to-five workday. There’s also a need to document care interactions in the electronic record and order testing and imaging or enter prescriptions. In a larger health care system, primary care doctors might be seeing a high volume of patients, which means these factors are multiplied. It can be very time-consuming and stressful.”

Despite the potential drawbacks, though, Dr. Carek remained passionate about family practice and sees the family care doctor as the strong foundation for a patient’s continued health and well-being.

“More family medicine doctors are coming in, but we still need health care systems and medical schools to promote the importance of the field,” said Dr. Carek. “When you have a good primary care system, you have a good health system. As a primary care doctor, I want to keep people well – help them manage anxiety and stress, learn good sleep hygiene and empower them to stay healthy as a lifestyle versus experiencing painful and potentially costly illnesses. It’s really people keeping people healthy. It’s not the dollars and cents – it’s the person in front of you – the patient in front of you.”

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