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regarding your current guest's concern about the cost of tuition and compensation in primary care... 

i am a primary care physician.  i took a scholarship through the national health service corps, which paid for my tuition in medical school.  in return, i worked in a wonderful community health center / migrant farm clinic in hood river oregon.  there are PLENTY of NHSC sites in oregon, both rural and urban for loan repayment.  don't be discouraged!  i make a very good salary now (though am no longer at the chc due to burnout).

one issue i think deserves more focus in the educational realm of medicine, especially in primary care, is RESPONSIBLE management of chronic pain.  for example, rather than dispensing #240 vicodin per month to a patient who has a myofascial pain syndrome, let's TEACH this patient coping mechanisms, options to help keep them moving, focus on yoga, or exercise prescriptions.  i think there needs to be a new field in medicine called "MOVEMENT MEDICINE"!  too many primary doctors are TOO busy and don't have the time or energy to help patients with chronic pain syndromes learn how to function without the use of chronic opiates.  opiate addiction is rampant and quite frankly, out of control.  there is no evidence to suggest that long term opiates improve patient outcomes from chronic pain.  they tend to create more problems, including dependence, bowel dysfuntion, weight gain, and depression, to name a few.  

let's be more responsible about the psycho-social aspect of medicine!

posted 2 years, 3 months ago
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