“You are too smart to do primary care.”

I have heard this far too many times, directed at me and at others seeking career advice.  There are many reasons for the shortage of primary care doctors in the U.S., but at least part of it is this.  Smart, capable, successful trainees are discouraged from choosing primary care.  It is perceived as a less prestigious pathway than specializing.

The knowledge base of primary care does not take any less skill to master than that of specialists.  It is simply a different distribution: knowing something about every disease, test, drug, or problem that a patient could possibly have versus knowing more detail about one particular set of diseases, tests, drugs, or problems that affect your organ system of interest.  No matter what type of doctor you decide to be, you are committing yourself to life-long learning.

It is true that choosing primary care is not the smartest financial decision.  When you have a crushing load of educational debt to pay off, you have to consider the fact that specialists are paid better than primary care doctors.  And when work is valued more in monetary terms, you may feel that it is more important, more validating, and more indicative of success.

We need smart people in all branches of medicine, those with broad knowledge and those with specialized knowledge.  In order to meet the growing needs of our patient population, we need a sufficient proportion of trainees to choose primary care, in spite of the messages they receive from their academic medical centers and society at large, which devalue generalism as a career path.

The main reasons to choose primary care are not about money or prestige but the privilege of having longitudinal relationships with patients.  You have the opportunity to learn about all aspects of their lives, in illness and in health, and stick with them through every twist and turn their journeys take.  The formation of strong doctor-patient relationships requires an emotional intelligence that is not the focus of most medical training.

The “smartness” that is usually rewarded in trainees is the ability to memorize vast amounts of basic science and obscure facts about rare diseases.  What we need are new doctors who are good at dealing with uncertainty, listening to people, and seeking continual self-improvement.  Hopefully, enough of these new doctors will also take on the challenge of mastering the broad knowledge base of primary care.  We must have the humility to accept that we will not be the worldwide experts in any particular disorder, but we will be the experts in caring for our unique patients.

Tabor Flickinger is an internal medicine physician who blogs at Tea with Dr. Tabor.

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