Primary care is vanishing as a practice model

Regarding “Taking the E-ROAD” [Yale Medicine, Autumn 2007], I’d like to tell the academics who decry the decline in the number of primary care physicians why I left primary care in 1968. It had nothing to do with lifestyle or economics. I didn’t leave primary care, primary care left me.

The whole practice model was disappearing. I lay awake nights wondering what to do and told my patients that if they could scare up 1,500 families who would let me deliver their babies, treat their fractures, take care of their kids, etc., then I would stay. This was a feeling shared by many of my contemporaries. But the climate was rapidly changing and the academics were clueless as to the reasons. Family practice disappeared, never to return. The change wasn’t just within the medical community but in American society as a whole. As an example, house calls didn’t disappear because physicians wouldn’t make them but because people stopped asking for them.

The young doctor who wrote the article has never been exposed to one generalist supervising care. The medical school hospitals I am familiar with (Yale, where I went to medical school, and Dartmouth, in the area where I now live) have simply never had that model. And I don’t know that they can.

Following my wife’s surgery, a serious post-op problem was handled without talking to her family. Consults were gotten, care discussed and treatment ordered without talking to the patient’s spouse or family doctor until, after four days, in desperation, the husband (me, an M.D.) insisted the primary care M.D. be called. With his background knowledge the primary care M.D. corrected the problem immediately. When I protested the lack of communication I discovered that the primary care M.D. had no privileges even though he is part of the Dartmouth-Hitchcock Medical Center system. I have yet to be talked to by anyone but the intern—even three years later! Today’s medical student never sees the kind of practice that was once so common in community hospitals. He or she has no role model, a fact that is sad but true. The current primary care model bears no resemblance to what I knew and the modern version is no replacement.

Robert P. Gerety, M.D. ’52
White River Junction, Vt.