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In the Balance |

Too Lazy for Primary Care?

William G. Kussmaul III, MD
[+] Article and Author Information

From Hahnemann University Hospital, Philadelphia, Pennsylvania.

Potential Conflicts of Interest: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M13-1778.

Requests for Single Reprints: William G. Kussmaul III, MD, Hahnemann University Hospital, 230 North Broad Street, Room 1536, South Tower, Philadelphia, PA 19102; e-mail, w.kussmaul@verizon.net.

Author Contributions: Conception and design: W.G. Kussmaul.

Drafting of the article: W.G. Kussmaul.

Final approval of the article: W.G. Kussmaul.


Ann Intern Med. 2013;159(10):711-712. doi:10.7326/0003-4819-159-10-201311190-00010
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This commentary discusses the shortage of primary care physicians and its implications. The author asks whether specialists shun primary care because it is too difficult— perhaps some physicians are too lazy for primary care?

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Too many kids for specialty training?
Posted on November 21, 2013
Lynn Bentson
Albany Internal Medicine Group
Conflict of Interest: None Declared
I have been a primary care provider for 23 years , worked in the hospital one week of four for all of them. The job is impossible, the pay is ridiculous and by looking at the cars in the gym parking lot, I can see the specialists aren't working more hours.

Like almost everyone else in primary care, I had family responsibilities that meant another 3-4 years of fellowship were untenable. Internal medicine, like most of medicine, believes in the brain-uterine shunt. I graduated with honors, my current board scores would still make me competitive for a fellowship. Those I had 20 years ago were usually better than my single collegues of either gender that did go on

Being a parent of young children , and in our culture, especially being a mom , is often what determines career choice.  There are exceptions, great for those people, but the rule is, pregnancy and infant care do not mix well with flouro hours and 3 more years of procedural call. Not talking about it because it seems sexist is the most sexist thing of all.

Doctors Parking Lot disparities
Posted on November 29, 2013
Neil Louwrens, MD FACP
Dignity Health
Conflict of Interest: None Declared
I would profer that the ails of our current health care system are directly related to the disproportionate catering, by a plethora of entities, to costly sub-specialty services. Indeed, we salute our specialty colleagues in their performance of their highly skilled procedures. Undoubtedly, we need you. Whilst the pain of current change undoubtedly affects specialists, their affliction pales in comparison with those expereinced by their primary care counterparts.

The 'Doctors Parking Lot' analogy deserves even closer scrutiny. Surely no place better represents the huge disparity in physician appreciation. Here, brand spanking new specialty rides stand starkly contrasted to those procured by more modest means.

But perhaps most troubling of all, and a true sign of our collective dissolve, is the observation that once exclusive doctors parking lots have now become the home to vehicles of owners unaffiliated with direct clinical care.

Colleagues, these 'divide and conquer' assaults on physician cohesiveness can no longer be placed in the proverbial parking lot. We must, by mutual give and take, reach a more reasonable and equitable divide.
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