Opinion | Primary Care Was the Loser in Our Residents’ Popularity Contest …

Last week, I got the strangest email at work. (Actually, I get a LOT of strange emails at work, but that’s a column for another day.)

A few weeks earlier, I had gotten the usual request to attend the annual Junior Resident retreat, an event held in midtown Manhattan every year (and virtually during the pandemic) which includes members of our Department of Medicine speaking about different careers available as the rising junior resident class begins to think about what’s next in their lives. In prior years we’ve broken up into various rooms, where the residents who are interested in cardiology, rheumatology, gastroenterology, hematology, and all the rest, get to meet with members of the faculty to talk about career paths, the life of the fellows, how to negotiate a contract, and so much more.

After the first email, I confirmed that I would be there, happy to talk to the incoming Junior Residents about why a life in primary care is such an amazing and special thing.

Then came the second email: I was basically dis-invited. The administrators from the Department of Medicine essentially said that no one had signed up expressing an interest in a career in primary care outpatient medicine this year. (Scratch that, I guess they did say that one had an interest in a particular subspecialty but that they also were considering primary care, perhaps as a fallback option. But with such little interest from the group, they suggested that there might be better uses of my time, and that I needn’t bother coming down for the afternoon.)

Somehow, in the midst of all we’ve been through, looking at the state of the healthcare system, thinking about and wishing for all that we think primary care can be, this felt kind of like the last straw. It made me want to cry.

Now I know, all over the country, there are residents who are finishing up their internship year, junior year, and senior year, and heading off towards and into careers in primary care. They are joining faculty practices, looking to build clinician-educator careers or clinician-researcher careers. Or they’re joining large private practices and concierge medicine models, among many others. But this felt particularly telling that in our large residency, there is no significant interest in a life of primary care.

I can’t really blame the residents. Their exposure to the life of primary care, as much as we try to communicate the joy that we feel in doing this calling, is one of chaos with an added dose of systemic indifference.

Our institution is of course a tertiary and quaternary care center, and for years, many in our department have said that the residents come here to learn to be specialists, super specialists, or super-duper specialists, trained by the best of the best with the most cutting-edge technology and learning the latest treatments, to advance their fields and do amazing research and more. But it would seem that a place like ours should also have a vested interest in turning out the finest primary care doctors dedicated to providing outstanding preventive care and acute and chronic care for everything that a subspecialist doesn’t want to be “bothered with,” that falls beyond their purview.

Our practice — like most that serve everyone in the community regardless of insurance type — is vastly under-resourced, with little of the support one would usually see in private practice, and all of the other primary care practices across our institution seem to suffer the same lack of infrastructure support.

As we awaken in the new world of healthcare and recognize the inequities that exist, I would hope that our institution, and many others, would start to feel that investing in primary care, and once again making it the heart and soul and foundation of all of medicine, would be worth it.

What better way to take care of everybody, to give everyone the right care at the right time in a way that we would all want to be treated, than to build an excited, invested, and eager group of young doctors desperate to provide care to their patients, their communities, and the world?

I’m not saying we don’t need amazing researchers working in labs developing ground-breaking treatments for every single disease, and I’m not saying we don’t need hospitalists, that we don’t need intensivists, that we don’t need proceduralists. But wouldn’t the healthcare system, and the world in general, be better off if we had a lot more dedicated, happy, and non-burned out primary care doctors desperate to set off on a lifetime career taking really good care of all the people?

Once again, I don’t blame these residents. The experience they have coming to our practice can be difficult — a busy schedule full of patients, less-than-satisfactory support, endless forms and clicks in the electronic health record, and rules and regulations that they don’t understand, because who could? But I do think it’s time we woke up and recognized that strengthening the foundation of our society’s healthcare system should start with general internists, pediatricians, ob.gyns, psychiatrists, and everyone else practicing non-specialized medicine at the forefront of patient care.

Match Day also happened this week, and suddenly a whole new group of expectant excited doctors will be headed this way. If we give them an incredible outpatient primary care experience in their training, maybe they’ll want to stay on.

And maybe, if not this year or next, but soon… I’ll get invited back.