I stand by my original statement: for a Professional Choice, medicine (big tent) looks good as compared to accounting, etc. You have to Be There to Do It, and that makes most medicine (excepting Radiology, who have made it a point to disconnect themselves from their hospitals and medical staffs) a non-overseas-exportable choice for a profession.
Yes, Primary Care reimbursement stinks. Surprise. Everyone, med school applicants included, is aware of that going into school. (Why someone would choose a primary care specialty with a huge school debt is beyond me. Perhaps some schools should ask themselves why they preach Primary Care while charging 25K/yr tuition).
Yes, there is a primary care access problem. I often refer my ED patients to specialists for their outpatient workups because I have no generalists interested in the job.
And, let’s be honest. When patients come to my ED 30 minutes after leaving their doc’s office, it’s for a ‘second opinion’, and the put-downs about their primary care docs are astonishing. I know, “…that ER doc was clueless” is stock after an ED visit, but most patients (like you, gentle reader) would rather have a specialist than a generalist.
There, I said it, it’s out in the open. It’s all (mostly) about perception. We will collectively rant and wail about the dearth of generalists, but when you need diabetes management, it’s “call the endocrinologist”.
Medicine has problems. So do people. I don’t think those are disconnected statements.