Practicing at the Top of Your License is Not an Option for Primary Care Physicians
You don’t really need a medical degree to know how to follow an immunization schedule, to recommend a colonoscopy, or order a screening mammogram (as long as, in this country, there is a standing order - in some places, mass screenings are done outside the primary care system).
You also don’t really need a medical degree to enter data into an EMR.
And when you decide to order a test, how many of the EMR “workflow” steps really require your expertise? I mean, borrowing from my iPhone, you could say “order a CBC” and facial recognition could document that you are the ordering physician. Really!
And you don’t really need a medical degree to, as I put it, open and sort the (electronic) mail; an eye doctor’s report comes in and if the patient is a diabetic, I have to forward it to my nurse for logging, and if not a diabetic, just sign off on it. And don’t imagine there is time in our day, evening or weekend to actually read the whole report. Patient A saw their eye doctor - check. Next…
Primary care in this country is pathetically arcane and inefficient. And we have a shortage of primary care physicians, they say. If we could all practice at the top of our license, perhaps not. It’s time to reimagine, reinvent, reinvigorate!
Dr. Duvefelt, I greatly enjoy your posts, but I must disagree with you about this one.
My decades as a PA taught me something very important: While I might be adequately trained to do 80%+ of primary care, the more advanced training of a physician is needed to recognize that occasional patient whose uncommon diagnosis is masquerading as something more pedestrian. Physicians in primary care of any sort really do practice at the “top” of their licenses because they are must recognize and properly approach unusual presentations and uncommon conditions, including those that may be outside of their primary care specialty.
Thanks!
Could you expound on reimagine, reinvent, reinvigorate!