THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Friday, September 29, 1995 TAG: 9509290706
SECTION: LOCAL PAGE: B3 EDITION: FINAL
SOURCE: BY MARIE JOYCE, STAFF WRITER
LENGTH: Medium: 91 lines
For decades, they trudged with little fanfare, the foot soldiers on the front lines of medical care. They treated your child's cough and prescribed your father's blood-pressure medicine. They nagged you to watch your weight, quit smoking and get your baby vaccinated.
And they did it for less money than, say, a surgeon, and for less prestige in the medical world.
But that is changing. Primary care doctors are now a hot commodity, viewed by the government and insurance companies as crucial players in health care reform. And the message is preached to medical students: We need more of them.
That message was repeated many times Thursday at Eastern Virginia Medical School's observance of National Primary Care Day. The day is a kind of stand-down at medical schools around the country. Classes are canceled and students are told about the rewards of being the reliable family doctor.
Medical school administrators have said something must be done to steer more students into primary care.
For many years, primary care doctors were considered the bright lights of the medical profession. But that started to change in the early 1960s, when advancements and technology and techniques gave surgeons and other specialists a dazzling array of new options. Patients flocked to them. Their pay and prestige increased.
Since 1962, America's medical schools have produced more specialists than generalists.
If trends continue, the Council on Graduate Medical Education said in a 1994 report, the country will have 35,000 too few generalists and 115,000 too many specialists by the end of the decade.
The deficit also is important because 43 million Americans live in so-called ``medically underserved'' areas, said state Sen. Clarence Holland. These are usually rural or inner-city urban neighborhoods without enough doctors to serve the population.
The event at EVMS on Thursday started with an address from Holland, a physician who practices family medicine in Virginia Beach.
Medical schools have been working hard to change the trend, with some success. This is the third straight year that the percentage of graduating medical students who plan a career in primary care has increased, according to a survey of the Association of American Medical Colleges.
Market forces also are working to mold more students into primary care doctors. Health maintenance organizations and other ``managed care'' insurance companies are trying to reduce costs by discouraging patients from visiting the more expensive specialists.
In a typical HMO, a patient must visit his primary care doctor first for any condition that's not an emergency. If the patient goes to a specialist without a referral from the primary care doctor, the insurer won't pay.
At Thursday's event, students listened to panel discussions on such subjects as how to deal with health maintenance organizations and how to work with patients from different ethnic backgrounds.
In EVMS's 1995 graduating class, 49 students - 47 percent of the class - went on to train in primary care fields. Of those, however, some may later seek additional training in a specialty.
Student organizers also had set up a sort of job fair, with representatives from residencies - post-graduate training programs - in primary care fields.
In some cases, the panelists were preaching to the converted.
Adrienne Prestridge, a second-year student, already plans to go into pediatric primary care. ``I want to be a well-child doctor. I want to work with healthy kids and keep them healthy,'' she said.
And classmate Tamara Lazenby, who wants a career in family medicine, said she chose EVMS because it's a school that focuses on working with the patient ``instead of some research-based institution.''
But Michelle Schlosser still hasn't decided. ``I like the broad range and spectrum you see with primary care. Every day's going to be different.''
However, she's fascinated with the workings of the eye and the specialty of ophthalmology. Working intensely in a single discipline has a certain clarity and focus that's appealing, she said. ILLUSTRATION: Graphic
PRIMARY CARE
Primary care medicine generally is considered to encompass three
disciplines, all of which require post-graduate training:
Internal medicine - These doctors treat adults and focus mainly
on internal organs. Some have extra training in a ``subspecialty,''
focusing on a particular system or organ.
Pediatrics - These doctors provide a broad range of treatment for
children. They also may have training in a subspecialty.
Family practice - These doctors treat adults and children.
Some in the medical field also consider obstetrics and gynecology
a primary care field.
by CNB