Practice under Pressure: Primary Care Physicians and Their Medicine in the Twenty-First Century

By Timothy Hoff | Go to book overview

Chapter 5
The Routine and Nonroutine
of Primary Care Work

There are strong perceptions that exist among medical students and residents that primary care work is too routine and less stimulating than specialty work. This view produces a psychological disincentive among these groups to choose a primary care specialty. To the extent primary care is imagined as lifestylefriendly to students and residents in terms of having less intense, more flexible workdays, primary care may attract individuals looking for a healthier career choice while scaring away those who feel they deserve more given their training and personal sacrifices to become doctors. Central to this discussion is the nature of the work itself and how practicing PCPs see it.

This chapter examines primary care work in the early twenty-first century from the perspective of the individual PCP, and the types of patients and problems these professionals currently see on a regular basis. If today’s primary care medicine does not involve the hospital or procedural work, and instead centers on ambulatory, office-based care for mostly acute care and chronic disease management, does it automatically become less intellectually gratifying to those physicians doing it? In addition, given the changes in the business model within which PCPs practice, it is relevant to explore whether or not a more transactional delivery system that makes physicians churn patients through more quickly and with less interaction affects the level of complexity in doing any type of primary care work. The types of patients visiting primary care offices also shape the degree of difficulty encountered in a given clinical situation. Thus, it is not only the work itself that matters, but the context within which that work is performed and how PCPs adapt that determine whether or not the practice of primary care is routine.

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