Wednesday, June 9, 2010

Physician Workforce: Who Will Be the Next Wave of Family Physicians?

This is my response to an excellent blog post on June 4, 2010, by "The Common Sense Family Doctor" about "who will be the next primary care physicians?" He had a nice review of the situation regarding diminishing numbers of medical students selecting primary care for their specialty. Noting that the Patient Protection and Affordable Care Act will result in large numbers of newly insured persons seeking a primary care physician, he commented on primary care work force studies done by the Robert Graham Center and the Association of American Medical Colleges (AAMC).

The AAMC reviewed surveys of medical students from 1997-2006 selecting primary care specialties, concluding that women who intended to serve the underserved are the applicants to select. I know that group will most likely become family physicians (since only 2% of students select primary care internal medicine and pediatric primary care gets very few students) and do quite well in their chosen focus. A much larger group of family physicians is needed to serve the rest of us. My comments to his blog follow:

Being always suspicious of the AAMC, whose members delivered our current specialty maldistribution, I wouldn't tend to align with a direction they recommended. The women who want to serve the underserved should not be the lead category to serve a mostly not-underserved (but maybe soon to be underserved) American middle class. The future of American primary care (which now consists of family medicine and a small potential for primary care pediatrics) may also have to be radically redirected from the business-as-usual humble and compliant employees of misguided powers in the Medical Industrial Complex (MIC).

I wonder about huge numbers of military veterans entering medical school as warriors for their friends and family. Warriors who know the importance of a good story, a friend and a caring God. Warriors who are good at Facebook and Skype, who would love Twitter and comfortably connect to a vast array of professionals on Linkedin. Warriors who hug and cry when appropriate because they are wholehearted and comfortable with who they are.

Warriors who would easily commit to their patient's safety since they already know how to attend to the safety of their friends in hazardous situations. Warriors who understand the stewardship of scarce resources and the importance of citizenship. Warriors who are committed to the freedom of their patients as unique individuals with a singular but connected genome that allows for significant input to become that unique individual.

A Warrior-student will know how to stand up for what they believe while respecting and listening to the opinions of others. They will understand how to say no to illegal orders from a military commander and the same from elements of the MIC that seek to misdirect them toward maximizing profit with overuse of costly, sometimes harmful (e.g., CT scans) resources.

In The Four Fold Way, Angeles Arrien wrote of the Warrior role in each historic global tribe, as well as the Healer, Teacher and Visionary. She noted that, while individuals in each tribe had a major part of their identity in one role, each person has all four roles within. The role of Healer, Teacher and Visionary is within each physician already. The Warrior role may need an upgrade in the individuals who will ultimately be at the front lines of health care. If they have already been trained to function at the front lines in modern military conflict, they will have an advantage in their service to their patients.

(You may notice that I don't equate warrior with killer. There is a huge difference that I hope you can appreciate. I hope you also notice that no gender is exclusive to warriors, nor to military or combat veterans).

I just wonder if we can expand our considerations beyond the narrow perspective of the AAMC to remember the vastness of the populations that we Family Physicians serve. Wholehearted Warriors with recent military service may fit nicely in the future family medicine (and other primary care) team for America.

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