There is a lot of press these days about the messy state of health care in the US. One issue less apparent now but a major issue in the future is the shrinking percentage of medical school graduates entering primary care (family medicine, pediatrics, internal medicine). One reason is the massive debt load that medical students have, now averaging over $140,000 and many easily over $200,000. This is forcing more and more to forgo primary care fields and “head for the ROAD”, (AKA radiology, ophthalmology, anesthesiology and dermatology).

This trend is accelerating, and is the focus of an excellent New York Times article, Doctor and Patient – Primary Care’s Image Problem. The main problem is that America needs a lot more primary care doctors, especially as the country ages. And if we get universal health care, demand would be even higher. But the trend is not encouraging, and schools are scrambling to create more incentives to make primary care more attractive.

Not Just In America

Of course, this is an issue in many countries, and in China the lack of primary care doctors is far, far worse. China doesn’t even really have a concept of primary care; everyone goes to a specialist automatically, and there is no culture of primary care clinics. It’s a huge problem that the government is acutely aware of and is working on, but this is a 20-year type project for them just in terms of increasing the numbers of trained doctors, not to mention providing adequate pay and making rural work more attractive. Then, they have to change the cultural mindsets of Chinese to go to their primary care doctor first, and not continue to overwhelm their local city’s hospital specialists.