Health Care Renewal called my attention to a Over My Med Body posting suggesting another force pushing in the direction of fewer docs going into primary care, time spent with the patient during the clinical rotations in medical school. He points out that in the teaching clinics the primary care patient are zipped through in 15 minutes-never mind they might have 5 different illnesses and 10 different meds and three new complaints-while at the specialty clinics 30 minutes is allowed.The student has more time to understand what is going on and naturally feels better about the encounter there than in the primary care clinics which may well influence his choice of career path.
Dr. Robert Centor in his blog, DB'S Medical Rants, has repeatedly emphasized the importance of having adequate time as have I. So, we have medical students, physicians in practice and even retired physicians all agreeing about the importance of time.Yet third party payers and managed care have pushed to allow less time(more throughput) per patient encounter and it is the practicing and retired physicians who have allowed this to happen.
Of course, the even bigger driver in the demise of primary care physician and the underlying reason for the time crunch is the paying-with-someone else's-money- reimbursement issue which is discussed brilliantly by Dr. Roy Poses here.