Primary care medicine in Canada

Article Abstract:

Canadian medical students view primary care medicine more favorably and choose it as a specialty more often than do US medical students. Primary care medicine was established as a specialty by the Royal College of Physicians and Surgeons, to be practiced only by certified general practitioners and family practitioners. The Canadian government has established physician-payment policies that pay physicians specialty fees for practicing primary care medicine. Primary care physicians must complete a residency training and pass a qualifying exam for a license in that specialty. The Canadian government tries to fund an adequate number of medical students specializing in primary care medicine. Canadian primary care physicians earn almost as much as specialists, unlike US primary care physicians. Medical students in the US may choose higher-paying specialties because they have more debt than Canadian medical students. The US needs to make primary care medicine more prestigious and more financially rewarding compared to other specialities to increase the number of primary care physicians.

Canada, Beliefs, opinions and attitudes

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Managing primary care in the United States and in the United Kingdom

Article Abstract:

Primary care has been hailed as the solution to controlling medical costs and improving access to health care. The UK has a highly organized system to deliver primary care that may serve as a model for reform in the US. In the UK, there is universal health insurance through the National Health Service (NHS). General practitioners are contractors, not salaried employees, of the NHS. Patients must first be seen by the general practitioner of their choice, who then refers them to a specialist if necessary. General practitioners have no hospital privileges and perform only basic tests in their offices. The NHS pays for medical education and regulates physicians so that rural and inner-city areas are not underserved. In the US, primary care is provided by generalists and specialists as well as in hospital emergency rooms and urgent care centers. While the US may view the NHS as 'socialized' medicine, its well-defined structure and the continuity of care it provides should be goals of any reform efforts the US pursues.

Management, United Kingdom. National Health Service

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Where have all the primary care applicants gone?

Article Abstract:

In 1991, 19% fewer medical school graduates chose a residency in primary care than in 1986. A 1989 survey by the Association of American Medical Colleges found that only 22.5% of graduates professed an interest in primary care, down from 36% in 1982. This could be a reflection of the changing values of students; in 1988, 80% of college students thought it was more important to be well-off financially, double the percentage in 1968. The specialization of American medicine may deny health care to many residents of rural areas, since only generalists can see enough patients in these areas to support a practice. Specialization will also increase the cost of health care. Medical schools should begin selecting students who indicate an interest in primary care. Students should be encouraged to do clerkships in the community. Fees paid to primary care physicians should be increased. Government can work with medical schools to encourage medical students to enter primary care.

Training, Career choice

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