Seemingly with a few blinks of an eye, I am half way through Family Medicine residency. As my inbox collects recruitment emails, I am promised “outstanding opportunities” from metropolitan areas to rural Kentucky. Surely not every job is outstanding, but I think there is a lot to look forward to in Family Medicine and primary care at large.
Advances in pharma will continue to have palpable promising outcomes
The past fifteen years or so in Medicine have been electric. Let’s say at one point many years ago, you were a patient who developed a blood clot or a condition that required long-term anticoagulation. Not only did you earn yourself a medication you never wanted to take, but if you were placed on Warfarin, you just enlisted yourself into a poking schedule: being on Warfarin requires you to show up on a regular basis to have your blood tested for how anticoagulated you are. But beginning around 2010, many patients requiring anticoagulation no longer needed to take Warfarin and could take a direct oral anticoagulant like Xarelto or Eliquis—both of which do not require monitoring. And in recent years, doctors and their patients have been helped by diabetes medicines that improve heart failure outcomes, chronic kidney disease progression, and even help patients lose weight.
My hope is that primary care can be augmented by increased access to promising medicine. I have already seen multiple Medicaid-based plans include pricey medicine, like Jardiance, on their formularies. Maybe we can continue seeing progress like this in the future.
A different model of primary care will continue gaining steam
Insurance-based primary care has been the way since we’ve all known it. A patient comes into the office. He may or may not pay a copay. The doctor then bills the insurance company. That’s how it goes. Although seemingly simple, insurance-based primary care has challenged many physicians to the point of burn-out. Reimbursements from insurance companies can be minimal, causing physicians to feel the need to see a volume of patients that tires them out. In turn, doctors have less time with patients, and patients themselves have to wait longer to see their doctors or agree to see providers who are not doctors.
This can be frustrating for everyone, so some doctors and patients alike have moved to membership cash-pay practices. Coined Direct Primary Care, primary care doctors bill their patients directly on a monthly basis. Insurance is not involved. Patients receive more access to their doctors. Doctors take on a smaller patient panel. This may not be a great fit for all doctors or patients, but high levels of satisfaction are possible. I can see how the primary care market becomes diversified more than ever, especially with how popular membership based services have already become.
Artificial Intelligence will make this easier
The second computers became integrated into healthcare, some doctors basically said heckkkkk no. I know some offices that still do not use electronic medical records. Although doing notes can be easier with typing, the entire process of patient care requires more box clicking than I imagined. Doctors have adapted, whether it be hiring scribes to write notes or recording their encounters to be typed up by another person. But what if AI just listens in on patient encounters and writes the note? This is already happening in some offices. Some softwares are so sophisticated that they type out a visit summary for the patient when everything is done. If this becomes the norm and is executed well on a consistent basis—oooof….chef’s kiss.
Otherwise, I look forward to AI helping primary care doctors with wet reads of imaging prior to the radiologist reviewing the image. AI has the potential to guide physicians in approximating future risks for their patients based on their vitals signs, bloodwork, family history, physical activity, etc. Maybe AI can think up a way of eliminating fax machines too….?
Wearable technology will not impact primary care as much as hoped
A wearable heart monitor that is worn for an extensive amount of time definitely helps cardiologists and to a lesser extent primary care doctors. But the FitBits and Apple Watches of the world…I don’t see extensive utility for primary care purposes. Give me a pair of glasses that scans food for its calorie count and nutrition profile or a bracelet that announces the negative effects of smoking when it senses a cigarette held by its wearer. That would be neat.
Primary care will become a bit more popular amongst medical students
The ultra-competitive students aiming for Neurosurgery will still have their eyes set on the medulla, but I feel like there will be a slight increase in medical students who will become more interested in Family Medicine. Medical students have become more inclined to value lifestyle over the years. When I entered medical school, everyone and their grandmother appeared to be interested in Emergency Medicine. When I inquired with my classmates about it, a curiosity for critical care and high acuity patients was surprisingly not the consistent leading cause behind the field’s popularity. Rather, I often heard the tune of “you do XYZ amount of shifts a month; you only have to deal with one or two acute issues; you leave work and don’t bring home work with you.” My classmates were trying to define a lifestyle specialty the best way they could through a dreamy lens. I’d argue that these lens were also quite foggy. It’s a busy work environment to say the least. Just a few years later, Emergency Medicine has faced countless systemic pressures that have unfortunately made it fall precipitously in popularity, and some medical students have been looking elsewhere for lifestyle.
The reality of Family Medicine is that everyone needs a primary care doctor. This field is generally well-supported by specialists who augment care. The 9-5 office hours are better attained in Family Medicine than several other fields. There are very few nights and weekends, if any. You can pick what you want to do in practice versus what you want to send to someone else. You get to see your patients make the progress you aimed for. Thus, there is a sense of freedom, sustainability, and yes—lifestyle—that should draw eyes from medical students.
These views are my own.
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