Primary Care Medicine in the United States: A Clinical specialty, or Managed Care Travesty

Originally published at on December 20, 2019.

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Medical practice is a strenuous task of healing humans as a lone body within the context of its inexhaustible scope of individuality. It is one and the only science that arrives with indefinite capabilities, henceforth obliging knowledge on every aspect of our life without prejudice. Latter is a must-have to heal to the best of the healer’s ability. Mastery around the art of medicine is endless. But in today’s tainted world, such a notion is a matter of argued sentiment.

Medicine is one of the most (if not the only) politicized profession of history. It suffers division into many realms on many grounds for a multitude of justifications. Over the past two centuries, the practice of medicine has been utterly fragmented by politics and extortion, more so over the last few decades. It’s merely due to socioeconomic, bureaucratic, and political motivations, where some have lived relevance of the time and situation, others matter of personal reverence by physicians, but many derivatives of administrative longings such as influence and manipulation.

It was not until the early 18th-century when only a few states in the United States facilitated the introduction of medical specialties when already existed in Paris. At that moment, American medicine was dominantly a uniform practice system. Even today, every physician licensed to practice as a physician maintains the concomitant privilege of practicing medicine and surgery”.

Before the 19th-century reform, neither hospitals nor medical schools were publicly governed. Hereafter they faced pressure under” administrative” rationalization, which facilitated specialization on the European continent. Concomitantly, in Britain, the medical aristocracy was dashingly splitting up, institutionally, between physicians and surgeons. By the reform, accountability was coming to be increasingly peculiar.

The criterion in the United States was going to integrate three European adopted branches of medicine prescribing, physic, and surgery. But as cities developed, the separation of activities became more pragmatic. In 1765, after spending five years studying medicine abroad, John Morgan, a well-known founder of Public Medical Instruction in America, publicly declared constraining his medical career to physic by renouncing surgery and drug-dispensing. A half-century after Morgan’s decree, the Boston physician James Jackson, having already abandoned the practice of surgery, was called upon in 1818 to send a message to his patients clarifying his rationale for renouncing the practice of obstetrics.

Bereft of skepticism throughout its evolution, medicine has been broken down not by the personal preference of the healer but based on western socio-political bureaucracy and economic rent. Today we can encounter many specialties as well as sub-specialties that are merely supported by societies, boards, and organizations under the identical 19th-century concept of amenity and only continues to evolve into a more segregated system of faculty.

One of the most recent crazes is the theme of primary care medicine. The latest concept refers to the upbringing of a three-decades-old program assembly centered on the mission to reduce healthcare costs, make medical care accessible to everyone, and improve its efficiency. Primary Care Medicine is the health maintenance organization (HMO) preferred model for segregating a group of medical professionals under a single umbrella to conform to their objective. However, “Despite managed-cares fiscally driven strives” to acquaint primary care medicine as another embodiment of clinical discipline, yet hard to dismiss the reality that it’s nothing but a title ridden over their bureaucratic appointment of the particular job description; to medical doctors.”

Medicine is the science of curing the Human. The body and soul constitute the psychological and physical sphere, each with respective sub-components that conform. Without one part, there wouldn’t be any health,’ hence no life. To heal, a physician needs to appreciate somebody as a single existence. The mastery of convalescence is a skill set with its own particular sub-skills. Since one can never be perfect at every aptitude, one must acquire an adequate understanding of the right help from the correct peer. That’s how most people speculate that medical specialties are formulated. But in certainty, the painting of clinical domains is anything but that! For instance, attorneys, even though they select a specific legal arena to pursue, but solely incite through mentorship and preceptorship on the given skill, as there is no such dedicated path as family law specialty board for lawyers in the same connotation is one for family medicine.

A medical specialty is distinguished as the limb of medical practice concentrated on a defined group of patients, diseases, skills, or doctrine. In the preponderance of cases, a physician who advances from the medical academy must elect a practical path in one of those branches and pass a written exam to fulfill the minimum provision for a particular capability that supports that territory of medicine. Primary care medicine, in essence, neither has a clinical path nor possesses an assessment. Still, some departments are deemed to be considered primary care practices, such as family practice, pediatrics, and internal medicine. Except for the family practice that occurs as a broad-based training, logically, no other possesses a substantial basis for plummeting under the recent classification.

I have frequently spoken of Broad-based skillset vs. the vertical skills; and how they have been subjected to partiality to enforce economic-rent. In this article, I prefer to magnify the monopoly of primary care medicine.

What is Primary Care Medicine?

For the sake of assertion, while I was exploring the web for several definitions. I came across some descriptions from the American Academy of Family Practice (AAFP). Interestingly enough, it contains five distinct explanations! Without going into the details while attempting to interpret Primary Care, we must first comprehend the essence of the services delivered to patients; furthermore, we must identify who the primary care providers are. The realm of primary care contains a myriad of skill sets and backgrounds and, in allotted cases, may not be graduates of the medical doctor training scheme. Accordingly, definitions can be subject to variation, thus incomplete without any amended portrayal of the primary care practice.

The definition furnished by Wikipedia is the simplest one I could find. It defines the primary care physician (PCP) as one who provides both the initial medical care to the undiagnosed medical concern and offers continued care, not limited by cause, organ system, or diagnosis. Although the word primary has been nearly wholly utilized within the United States, phrases like General practitioners relate to similar intuition.