Why We’re Flocking to Sub-Specialties
As residency application season rapidly approaches, I’ve gotten into similar conversations with many friends about why they’re choosing a particular specialty, and one particular theme keeps coming out:
In subspecialty outpatient clinics, there’s more time to spend with patients: visits are usually scheduled as 30 minutes long.
In a world where we’re trained in primary care clinics at the pace that our attendings can keep up with (15 minutes per visit) and we’re feeling completely overwhelmed by trying to address the patient’s hypertension, diabetes, hyperlipidemia, peripheral neuropathy, prior MI, stroke, and liver disease (not to mention learning all the drugs and dosages), of course we like the specialties where we have more time to figure out all our patients problems.
(I’d also argue that we got into medicine to help patients, not just cure their diseases–and that medical students, just like residents and attendings, prefer to have the time to get to know our patients as people, not just as the guy with poorly controlled diabetes with hemoglobin A1C’s in the 10-12 range.)
I suspect many busy specialists are seeing patients every 15 minutes also. I see my new (primary care general internal medicine) patients for 30 minutes, and follow-ups are just 15, but I will schedule certain patients for 2 15 minute slots back to back. I have the good fortune to be salaried, and haven’t been told I have to see a certain number of patients. So I would tell you that it can be done in primary care!
Actually, where I go to school, the specialty clinics schedule follow-up patients q 15 minutes; new visits are 30 minutes or so. still a pithy amount of time, if you ask me. but for that 15 minutes of time, they may make more than if they were primary care docs…and often get to ignore the myriad of medical problems, honing in on only what they care about. not exactly the best way to practice medicine, but there you have it.
You are absolutely right, they DO make more, especially if they order procedures they will perform, AND because they don’t have to talk to patients about alot of the patients’ other concerns. It’s a perverse system, isn’t it?
I’ve always thought specialization may appeal to some young doctors because it offers the illusion of certainty–that one could master an apparently smaller body of knowledge, I suppose, and that seems comforting compared to the thought of being a generalist. But uncertainty in clinical practice is EVERYWHERE, because patients are individuals and much of what we have for science hasn’t included the study the persons we see every day in practice.
Hi Graham. Great posts, as always. What does this tell us all about how stupid our reimbursement system is? Primary care doctors, the very people who should be allowed to spend time with patients, talking to them, doing the COGNITIVE work that’s so essential to good medicine and good health care, are paid so poorly they have to cram in patients at 15 minute intervals. Instead, the subspecialists are the ones who can afford to spend time.
my dermatologist spend half an hour with me — chatting away, burning off this and that. I don’t really need half an hour with her. I need half an hour with my PCP. And if I have a chronic disease, I may need even more time.
All you docs out there reading Graham’s great blog should be yelling at Congress to fix the system so that PCPs are paid in a different way — because you are incredibly powerful. Congress won’t make a move unless it thinks physicians are in general agreement.
[...] I’ve commented on this before, but it seems silly to give specialists more time with patients than primary care docs. Sure, [...]
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