Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • 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

We are training physicians to take care of the 1%

Andrew Morris-Singer, MD
Education
May 10, 2013
Share
Tweet
Share

“That makes no sense!” a friend recently blurted out to me after I finished helping her understand how the vast majority of internal medicine residents are trained in this country. Her incredulousness was less about the “how,” and more about the “where.”

No doubt. When you consider that the overwhelming majority of practitioners will ultimately be practicing almost exclusively in the outpatient environment, and that cost-conscious healthcare reform efforts are specifically trying to replace hospital-based, predominantly late, “sick care” with proactive and preventative ambulatory care, it’s remarkable that future physicians spend so much of their time training on the wards of academic hospitals. The research supports what so many of us avidly question.

For some time, a number of primary care advocates have been trying to call attention to the imbalance between ambulatory and hospital-based training in this nation. They have grown impatient with the manner in which inpatient, largely reactive care, is prioritized in curriculum while primary care is treated as an afterthought, at best, or superfluous at worst. And these advocates have grown increasingly frustrated watching this phenomenon drive unnecessary health spending tied to overprovision of expensive tests, overutilization of inpatient services, and a lack of commitment to basic prevention and coordination activities.

But while primary care advocates are tuned in to these problems, the typical patient has no idea of the level of dysfunction. And honestly, I can’t help but wonder if they would even see the current situation as problematic. Americans are in love with technology. They view specialization as progress. Many patients would voluntarily go for the full body CT scan (much to the horror of their primary care practitioners), as they’ve been taught to believe that more information and tests are better. The academic hospital, housing the most cutting-edge technology, biomedical science, and specialized medical professionals, therefore, becomes the Promised Land.

Yet only 1% of American patients will be treated in these super-specialized institutions in any 3-month period. The vast majority of us have a set of healthcare needs requiring treatment approaches that can’t be found within most of these institutions. “We don’t carry that,” would be the honest response an average American would hear if they approached the academic hospital information desk to find out where in the hospital they could go to get help to lose weight non-surgically, control their blood pressure and other chronic diseases, find resources to treat their depression and anxiety, or meet health coaches to help them manage their overall health. “But that’s what I need,” they’d say. “That’s what the vast majority of us need!”

So if that’s what your average American needs to promote and protect their health, and those things are frequently absent from the basic services of the academic hospital, why do almost all of our trainees spend the preponderance of their medical training confined to these halls, taking care of the 1%? You’re probably thinking, “This is partly due to our collective desire to prepare them to be able to identify and care for the sickest of the sick and manage difficult diagnostic dilemmas.” But does that require that they spend two-thirds of their time in the hospital? Is it possible that our predominantly hospital-based approach to training is leaving the next generation of practitioners relatively ill-prepared to care for the other 99% of us?

“Let me make sure I understand this,” my friend continued after I laid this all out for her. “It’s as if we took all of the veterinary students in the US, sent them off to the Galapagos Islands for 3 years to care for swimming lizards and flightless birds, and then brought them back to the US and expected them to figure out what’s wrong with our cats and dogs. They wouldn’t know where to start! They’d probably think my cat, Sprinkles’, purr was pathological or something…and they’d end up ordering a billion tests to figure out if she was dying! They might even stick a needle in her.”

Precisely.

Andrew Morris-Singer is an internal medicine physician and president and co-founder, Primary Care Progress.

Prev

The advantages of having a connected EHR

May 10, 2013 Kevin 6
…
Next

Dealing with depression has made me a better doctor

May 10, 2013 Kevin 7
…

Tagged as: Medical school, Primary Care, Residency

Post navigation

< Previous Post
The advantages of having a connected EHR
Next Post >
Dealing with depression has made me a better doctor

ADVERTISEMENT

More by Andrew Morris-Singer, MD

  • a desk with keyboard and ipad with the kevinmd logo

    National Primary Care Week 2012: What makes this year different?

    Andrew Morris-Singer, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Real health reform cannot happen without a primary care foundation

    Andrew Morris-Singer, MD
  • a desk with keyboard and ipad with the kevinmd logo

    It’s time for a primary care workforce surge

    Andrew Morris-Singer, MD

More in Education

  • Why medical schools must ditch lectures and embrace active learning

    Arlen Meyers, MD, MBA
  • Why helping people means more than getting an MD

    Vaishali Jha
  • Residency match tips: Building mentorship, research, and community

    Simran Kaur, MD and Eva Shelton, MD
  • How I learned to stop worrying and love AI

    Rajeev Dutta
  • Why medical student debt is killing primary care in America

    Alexander Camp
  • Why the pre-med path is pushing future doctors to the brink

    Jordan Williamson, MEd
  • Most Popular

  • Past Week

    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
  • Past 6 Months

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • How medicine repurposing enables value-based pain management and insomnia therapy

      Olumuyiwa Bamgbade, MD | Meds
    • Finding balance and meaning in medical practice: a holistic approach to professional fulfillment

      Dr. Saad S. Alshohaib | Physician
    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How regulatory overreach is destroying innovation in U.S. health care

      Kayvan Haddadan, MD | Physician

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 9 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

  • Most Popular

  • Past Week

    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • The One Big Beautiful Bill and the fragile heart of rural health care

      Holland Haynie, MD | Policy
    • Why health care leaders fail at execution—and how to fix it

      Dave Cummings, RN | Policy
    • How digital tools are reshaping the doctor-patient relationship

      Vineet Vishwanath | Tech
  • Past 6 Months

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • How President Biden’s cognitive health shapes political and legal trust

      Muhamad Aly Rifai, MD | Conditions
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • The hidden health risks in the One Big Beautiful Bill Act

      Trevor Lyford, MPH | Policy
  • Recent Posts

    • America’s ER crisis: Why the system is collapsing from within

      Kristen Cline, BSN, RN | Conditions
    • Why timing, not surgery, determines patient survival

      Michael Karch, MD | Conditions
    • How medicine repurposing enables value-based pain management and insomnia therapy

      Olumuyiwa Bamgbade, MD | Meds
    • Finding balance and meaning in medical practice: a holistic approach to professional fulfillment

      Dr. Saad S. Alshohaib | Physician
    • Forced voicemail and diagnosis codes are endangering patient access to medications

      Arthur Lazarus, MD, MBA | Meds
    • How regulatory overreach is destroying innovation in U.S. health care

      Kayvan Haddadan, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

We are training physicians to take care of the 1%
9 comments

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

Loading Comments...