Theresa Chan is a hospitalist physician in rural California. When she started out, she had the ideal of “doing it all,” which is the type of doctor that is needed the most:

When I arrived in Rural I was determined to do it all: see patients for primary care, admit them to the hospital, assist surgeries, deliver babies–everything . . . I did I&Ds, skin biopsies, colposcopies, IUD insertions and endometrial biopsies. I saw patients for 30-32 hours per week, slugged through charts and paperwork another 10 hours per week, and took call every Thursday and one weekend per month.

Then reality hit, and she was forced to deal with the harsh truths of primary care medicine. Some were unique to her situation, others could felt by generalists nationwide.

Economic factors were noted to play a role, as the compensation was not commensurate with the amount of work she did:

Now, I’m sure you can argue that $95,000 in direct salary is twice the national average for a two-person family, so surely I can’t cry poor–and you’d be right. However, I didn’t say my salary wasn’t enough for me to keep body and soul together . . . Given the rapid rise in property prices in California between 2001-2004, including Rural County, I could not have bought a house on $95,000 of direct income a year . . .

Primary care is where the best and the brightest physicians are needed the most. Any hope of health care reform depends on the availability of generalist access.

If dedicated doctors like Dr. Chan is leaving the field for greener hospitalist pastures, you can be sure that the same decision is being made by countless others across the country.