[strikelaserclaw]

To be perfectly honest, i have found primary care doctors pretty useless in the last 5 - 10 years, not only did i find that their answers were things i could easily find on google, i also noticed that most of them didn't actually care about patient well being. It seems like most doctors these days are only in it for the money, which is fine if they are actually providing a valuable service, but low level doctors are nothing more than glorified drug dealers at this point.

[namelessoracle]

This is sadly true.

There is basically no value in a general medicine doctor that i can see. General health issues can be handled by a nurse practitioner, they can see if you have an ear infection, are sick with the flu, and proscribe you the antibiotics, or other controlled medicines just fine. They could easily switch to a model where the General Medicine doctor acts as like the staff engineer over the senior devs, and just does a quick plus one on their results and makes sure no mistakes were made. (this is how most doctors visits play out anyways)

When there IS something seriously wrong, they almost always send you to a specialist who can actually treat your specific issue. Have a really bad ear infection / something is lodged in your ear? Here is the ENT referral! Pay me for telling you to go see the ear doctor when you had ear problems.

[kashunstva]

Former general internist here. I obviously have opinions about the assertion that generalists provide no incremental value. The model you posit, wherein a generalist oversees a panel of NP’s and PA’s is already common. Many primary care problems can be handled in this way. No disagreement. But there is a host of multi-systemic disorders that most mid-level practitioners would never recognize. And do you think most subspecialists are interested, aside from the occasional rheumatologist, in comprehensive management of the protean manifestations of most of these types of disorders. This coordination of care for complex disorders has to be done by someone. And for the sake of the patient I hope it’s someone with a solid command of pathology, physiology, pharmacology and so forth. And maybe someone with the time and empathy to talk to actual humans. If you think coordination of care is handing out referrals, that’s a massively reductionist view.

[namelessoracle]

What you are talking about is ideal state. My experience is literally its always "here's the referal" if i talk about anything specific and the standard host of anti biotics and standard z pac style medicines dont clear it up. Always.

Now my view might be biased because i have been given Kaiser as my provider and i know they have incentives in their system that arent the norm. But its always a specialist referral. Ear problems that the anti biotic didnt solve? ENT referral! (the ENT laughed and said the general medicine doctor made the problem actively worse with the multiple types of anti biotics proscribed sense it was a fungal infection in the ears). Skin issue? Here's the dermatologist referral! Shortness of breath after working out? Here's the pulmonology referal if you want it. Your knee hurts? Here's the rheumatology referral.

I am legit curious what medical service the doctor would provide. You mention "multi-systemic disorders that most mid-level practitioners would never recognize" do you have an example of that?

[thfuran]

A doctor in it for the money is pretty unlikely to go into primary care.

[strikelaserclaw]

They usually set up their own clinic and rake it in, tons of primary care doctors i know did this.