Trouble in primary care city

"We all have enough strength to endure the misfortunes of others."-François de la Rochefoucauld

If you are a regular reader of this column, then you know that several months ago I lamented the limited-to-nonexistent exposure of medical students to ophthalmology. My concern was that excellent students would no longer entertain a career in ophthalmology, easily one of the most rewarding fields of medicine (my opinion).

Compared with some other fields, I now realize, we in ophthalmology have nothing to worry about.

Hopkins' leaders in this field offered some explanations for this trend. Our chief of the Division of General Internal Medicine (Fred Brancati, MD) says: "the economics of primary care practice are deadly." Medical student debt, the article points out, is almost 5 times more today than 20 years ago. Internist Redonda Miller, MD, hypothesizes that "the new generation of MDs, which includes an increasing number of women, want to spend more time with their families."

The most worrisome part of the article to me was the concluding paragraph, stating that Hopkins' leaders in the field have "no concerted plan . . . to deal with the primary care physician shortage." My reaction to reading this was that they better get a plan. The article opines that "the solution may lie in conveying to students, interns, and residents the rewards of following patients throughout their whole lives. 'No other kind of practice can duplicate that satisfaction.' "

With all due respect, they need a better solution. I know it's wrong to kick people when they're down, but as an ophthalmologist I have followed patients for a very long time, and it's hard for me to envision a practice as satisfying as ophthalmology.

Is there a solution, or is the general internist destined to follow the carrier pigeon and coelacanth into extinction or near-extinction? Will nurse practitioners take over this field? If there is a solution to offer our primary care colleagues and you know it, please share it with me and I'll pass it on to our primary care leaders here. And you'll have done your good deed for the day.

When I look at what's going on in the primary care field, I resolve to quit complaining about how we in ophthalmology are doing. But that resolution lasts about as long as my resolutions to exercise more regularly and to eat healthier foods.

Peter J. McDonnell, MD is director of The Wilmer Eye Institute, The Johns Hopkins University School of Medicine, Baltimore, and chief medical editor of Ophthalmology Times. He can be reached at 727 Maumenee Building, 600 North Wolfe St., Baltimore, MD 21287-9278 Phone: 443/287-1511 Fax: 443/287-1514 E-mail: pmcdonn1@jhmi.edu