VIEWPOINT Primary care: a call for a return to ethics and values
Steve Kuperberg writes about his views on the importance of ethics in primary care.
With the recent deluge of attention to the dire need for primary care reform, numerous leading theories have been endorsed as solutions to increased demands on a shrinking and often disillusioned primary care workforce. Most of the potential solutions focus on reimbursement overhaul through changes in policy, restructuring payment systems, and even restructuring the means by which primary care is delivered.However, a fundamental issue must be added to these strategies. As physicians and physicians in training, it is essential to remind ourselves and our peers the very reasons why we entered medicine at the start, and that is “for the patients.” Granted, adequate remuneration is absolutely necessary, both for the mountains of loans accrued by the average medical student, as well as for continued job satisfaction. However, there are countless means of employment outside of medicine where compensation is higher and has greater upside potential. We went into medicine for the benefit of those we serve, with the intent of serving a common good. Over the course of my four years of medical school training, it seemed from the very start that this ethos was rarely found, and that there is a seemingly unstoppable trend towards overshadowing the goal of healing patients with that of purely financial gain.
I believe the true solution is an integration of both the practical and the ideal. There must be a policy shift towards better compensation for those who choose to practice primary care, which is perhaps the single most important component of the healthcare system at large. But there must also be a return to the core values that consider patient needs first. This is the responsibility first of the student, who must maintain a moral compass on this issue, potentially in the face of others who may be diverging towards more lucrative specialties for the sake of their salary. It is the responsibility of our medical institutions, regardless of country, to teach students and integrate into their curricula the importance of primary care and the need for caring newcomers to enter the field. Finally it is the responsibility of our national leaders, who have the power to institute changes that overwhelmingly favor salary increases and practice support in primary care specialties. In doing all of this we will put patients first, for it is to the patients we owe the greatest debt.
Steve Kuperberg, 4th year medical student at the Ross University School of Medicine, New York, NY, USA.
stephenkuperberg@rossmed.edu