Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
KevinMD
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking
KevinMD
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking
  • About KevinMD | Kevin Pho, MD
  • Be heard on social media’s leading physician voice
  • Contact Kevin
  • Discounted enhanced author page
  • DMCA Policy
  • Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices
  • Group vs. individual disability insurance for doctors: pros and cons
  • KevinMD influencer opportunities
  • Opinion and commentary by KevinMD
  • Physician burnout speakers to keynote your conference
  • Physician Coaching by KevinMD
  • Physician keynote speaker: Kevin Pho, MD
  • Physician Speaking by KevinMD: a boutique speakers bureau
  • Primary care physician in Nashua, NH | Doctor accepting new patients
  • Privacy Policy
  • Recommended services by KevinMD
  • Terms of Use Agreement
  • Thank you for subscribing to KevinMD
  • Thank you for upgrading to the KevinMD enhanced author page
  • The biggest mistake doctors make when purchasing disability insurance
  • The doctor’s guide to disability insurance: short-term vs. long-term
  • The KevinMD ToolKit
  • Upgrade to the KevinMD enhanced author page
  • Why own-occupation disability insurance is a must for doctors

Don’t make me leave primary care

Lydia Dugdale, MD
Physician
January 21, 2013
Share
Tweet
Share

You need a doctor, and I love what I do. But this work just isn’t sustainable.

In 2009, I finished medical training and joined a clinical academic practice. For those not in the know, doctors can — very generally speaking — work in one of two domains: in private practice, or on faculty at a medical school where they see patients, teach, and/or do research. Some docs manage to keep a foot in both academics and private practice, but for most, it’s one or the other.

I stayed in academic medicine for many of the reasons that my colleagues did: to be immersed in the front lines of new knowledge, do a bit of teaching, and care for complex and diverse patients. I chose a salaried position, unencumbered by concerns of paying overhead or running a business. And even though academic physicians tend to earn less than those in private practice, I have no question that I am in the right place. I love my work. And more importantly, I love caring for my patients.

But primary care is broken across the board. The work is unsustainable. I’ll tell you why.

For a start, the pace is manic. In our clinic, we see established patients roughly every 15 minutes. This flows well when the patient is a young healthy woman on no medications coming in for the common cold. But what about the 70-year-old man with diabetes, high cholesterol, high blood pressure, and prostate trouble? He sees four specialists and takes 17 medications, is retired and enjoys chatting. Even though he keeps in his wallet a list of his pills, he forgets to update it. We spend six minutes fixing his medication list, eight minutes reviewing the recommendations of his sub-specialists, and he hasn’t yet mentioned the reason for the visit. You don’t need to be a mathematician to calculate why your doctor is always in a rush.

If the primary care doctor’s only task each day were to see patients within a very limited time frame, it might be doable, but unbeknownst to many outside of medicine, the doc does so much more. How much? A recent study in the Archives of Internal Medicine looked at clinics just like mine — academic general internal medicine practices — and for the first time ever attempted to quantify “the work no one sees.” The researchers found that in a typical clinic day, the general internist completes electronic orders for 70 laboratory tests, images, and consultations; writes and signs 31 prescriptions; responds to seven patient care-oriented messages; and reviews, edits, and signs 19 electronic medical documents. Most of this occurs outside of face time with patients, and — they postulate — this estimate is conservative.

But it’s not just that time is short and busy work abundant; primary care doctors also increasingly struggle with job satisfaction. Why? Two reasons. First, we primary care doctors take pride in being the “people people” among doctors, but time constraints force us to emphasize strategic decision-making over relationship. As much as I’d like to engage my talkative retiree, an extra five minutes per patient puts me over an hour behind at the end of the morning clinic session and imposes on the afternoon schedule. And yet, I need to talk with my patients, and they need to talk to me. These conversations build trust, clarify patient wishes as well as misunderstandings, and result in improved care all around.

We primary care doctors take pride in the jack-of-all-trades-ness of our specialty, but in practice, we do less and less medicine. Rather than master diagnostician, the internist often feels more like a glorified vending machine. Push enough buttons and you just might get what you want, regardless of whether it’s good for you.

I anticipate the response to my observations to be along these lines: Stop whining; other professions have it harder than you do. You chose this. You make a decent salary. You have job security.

Yes, all of those things are true. But when the unrelenting pace, scope, and quality of work leave me so mentally taxed that I am unable to engage my children or spouse night after night, then something must change. At the end of the day, the healers themselves must be healthy in order to continue the work of healing others.

The insufferable pace of primary care combined with the erosion of the doctor-patient relationship deters young physicians from entering the field. In my graduating class of 30 or so internal medicine trainees, only two of us chose to go into primary care. The vast majority picked sub-specialties with a narrower scope of work and a higher salary.

What can be done? I offer two simple suggestions as starting points. First, medical students need greater incentives to choose primary care. Currently, programs exist to help reduce student loans for physicians practicing in certain low-income settings, but individual states need to offer grants to reduce student loans for all primary care doctors accepting state insurance. For my part, as a working mother of two, more than 60 percent of my monthly salary goes to my student loan payments and to child care. There is almost no financial incentive for me to work.

Second, primary care doctors need more resources. More assistance with paperwork and telephone calls translates into greater opportunity to spend time with patients and practice the art and science of medicine. It is for my patients, after all, that I became a physician.

ADVERTISEMENT

Primary care is in crisis, and I am here to work. Please help me to stay.

Lydia Dugdale is an internal medicine physician who blogs at Primary Care Progress.  This article originally appeared in The Huffington Post. 

Prev

An excellent primary care doctor is your trusted health care advisor

January 21, 2013 Kevin 3
…
Next

When is making the decision to be DNR appropriate?

January 22, 2013 Kevin 4
…

Tagged as: Primary Care

< Previous Post
An excellent primary care doctor is your trusted health care advisor
Next Post >
When is making the decision to be DNR appropriate?

ADVERTISEMENT

More by Lydia Dugdale, MD

  • How perceiving beauty makes us better doctors 

    Lydia Dugdale, MD
  • Might doctors be inclined to facilitate the deaths of patients they don’t like?

    Lydia Dugdale, MD

More in Physician

  • What got you here won’t get you there: a physician’s guide to leadership

    Harvey Castro, MD, MBA
  • The 3-2-1 method: a doctor’s guide to keeping New Year’s resolutions

    Anthony Fleg, MD
  • Learning from patients: How a physician gained strength and resilience

    Samantha Fernandes, MD
  • Rural emergency medicine in New Mexico: a physician’s firsthand account

    Sarah Bridge, MD
  • What the folinic acid retraction means for autism treatment

    Timothy Lesaca, MD
  • The pause medicine never taught us to take

    Mary Wilde, MD
  • Most Popular

  • Past Week

    • Missed diagnosis visceral leishmaniasis: a tragedy of note bloat

      Arthur Lazarus, MD, MBA | Conditions
    • Sabbaticals provide a critical lifeline for sustainable medical careers [PODCAST]

      The Podcast by KevinMD | Podcast
    • Menstrual health in medicine: Addressing the gender gap in care

      Cynthia Kumaran | Conditions
    • Single-payer health care vs. market-based solutions: an economic reality check

      Allan Dobzyniak, MD | Policy
    • Executive order on homelessness: Why forced treatment fails

      Gary McMurtrie | Policy
    • Tobacco cessation offers untapped revenue for medical practices [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Missed diagnosis visceral leishmaniasis: a tragedy of note bloat

      Arthur Lazarus, MD, MBA | Conditions
    • Alex Pretti: a physician’s open letter defending his legacy

      Mousson Berrouet, DO | Physician
    • Health care as a human right vs. commodity: Resolving the paradox

      Timothy Lesaca, MD | Physician
    • The American Board of Internal Medicine maintenance of certification lawsuit: What physicians need to know

      Brian Hudes, MD | Physician
    • Why voicemail in outpatient care is failing patients and staff

      Dan Ouellet | Tech
    • AI-enabled clinical data abstraction: a nurse’s perspective

      Pamela Ashenfelter, RN | Tech
  • Recent Posts

    • What got you here won’t get you there: a physician’s guide to leadership

      Harvey Castro, MD, MBA | Physician
    • The 3-2-1 method: a doctor’s guide to keeping New Year’s resolutions

      Anthony Fleg, MD | Physician
    • Single-payer health care vs. market-based solutions: an economic reality check

      Allan Dobzyniak, MD | Policy
    • Learning from patients: How a physician gained strength and resilience

      Samantha Fernandes, MD | Physician
    • Early screening saves limbs from silent vascular disease [PODCAST]

      The Podcast by KevinMD | Podcast
    • The “ethical canary”: How moral injury signals systemic failure

      Courtney Markham-Abedi, MD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 21 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Missed diagnosis visceral leishmaniasis: a tragedy of note bloat

      Arthur Lazarus, MD, MBA | Conditions
    • Sabbaticals provide a critical lifeline for sustainable medical careers [PODCAST]

      The Podcast by KevinMD | Podcast
    • Menstrual health in medicine: Addressing the gender gap in care

      Cynthia Kumaran | Conditions
    • Single-payer health care vs. market-based solutions: an economic reality check

      Allan Dobzyniak, MD | Policy
    • Executive order on homelessness: Why forced treatment fails

      Gary McMurtrie | Policy
    • Tobacco cessation offers untapped revenue for medical practices [PODCAST]

      The Podcast by KevinMD | Podcast
  • Past 6 Months

    • Missed diagnosis visceral leishmaniasis: a tragedy of note bloat

      Arthur Lazarus, MD, MBA | Conditions
    • Alex Pretti: a physician’s open letter defending his legacy

      Mousson Berrouet, DO | Physician
    • Health care as a human right vs. commodity: Resolving the paradox

      Timothy Lesaca, MD | Physician
    • The American Board of Internal Medicine maintenance of certification lawsuit: What physicians need to know

      Brian Hudes, MD | Physician
    • Why voicemail in outpatient care is failing patients and staff

      Dan Ouellet | Tech
    • AI-enabled clinical data abstraction: a nurse’s perspective

      Pamela Ashenfelter, RN | Tech
  • Recent Posts

    • What got you here won’t get you there: a physician’s guide to leadership

      Harvey Castro, MD, MBA | Physician
    • The 3-2-1 method: a doctor’s guide to keeping New Year’s resolutions

      Anthony Fleg, MD | Physician
    • Single-payer health care vs. market-based solutions: an economic reality check

      Allan Dobzyniak, MD | Policy
    • Learning from patients: How a physician gained strength and resilience

      Samantha Fernandes, MD | Physician
    • Early screening saves limbs from silent vascular disease [PODCAST]

      The Podcast by KevinMD | Podcast
    • The “ethical canary”: How moral injury signals systemic failure

      Courtney Markham-Abedi, MD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today

Copyright © 2026 KevinMD.com | Powered by Astra WordPress Theme

  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Don’t make me leave primary care
21 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...