Perry

Family medicine has always had the reputation of advocacy for patient needs, whereas those in many other areas of medicine advocate for better pay. Our advocacy has given us a certain amount of credibility. However, over the past decade this has led to very little increase in financial support. We have become increasingly frustrated about the pay scale. What we provide is just as valuable as that provided by those in specialized areas of medicine. We have made microscopic improvements along this line. Furthermore, we have lost a bit of our credibility by advocating for better pay. We are damned if we do and damned if we don’t.

The challenge is that we can drown people with evidence for primary care. That is not the issue. We have plenty of evidence. The issue is one of convincing the federal government to provide adequate financial support for the work we do. The financial support just isn’t there.

How do we change the minds of people? Clearly, the rational approach isn’t working. We need a different approach—but it is not clear what that approach should be—because if we try something different it seems to work against us.

The problem is that even with the escalating need for primary care, our medical students don’t want to work that hard—while being on the bottom of the totem pole (both with regard to remuneration and social status). Those in primary care are tired of being the outliers, the missionaries: “Why is what I do less appreciated?”

In terms of evidence, we have even begun to show convincing evidence regarding the Complexity of what we do. If you are a rheumatologist, then your entire practice is one of four diagnoses. There is a lot less complexity for these specialists than for us in primary care who must treat people who come in with undifferentiated problems, bizarre descriptions of symptoms, and underlying social determinants of ill health. It’s kind of like being a social worker, kindergarten teacher and first responder at the same time – yet it is less appreciated.