Is Primary Care the Best and Worst Job in Medicine?

Marty Levine, MD, of Shoreline, Washington, doesn’t practice medicine in the same way that most primary care physicians do today.  He hasn’t worried about billing anyone for two years.  He takes his time with each patient, often lingering over medically irrelevant conversations about patients’ cats or grandkids. When it’s time to fill out a patient’s electronic health record, he pulls up a chair alongside the patient and they do so together.  He works closely with a team of health coaches who not only make sure that every patient in his practice understands and follows through on his or her care, but that it’s exactly the right care for that particular patient. On occasion, he makes honest-to-goodness house calls. 

“I feel fortunate to work here,” says Dr. Levine, who is employed by Iora Health, a small but growing group of practices that provides medical home–style care to about 40,000 people in 11 states. The medical home model emphasizes patients’ needs, rewards good outcomes, and gives practitioners all kinds of support. “Iora has designed a care model that supports real primary care and lets me focus on being a doctor.  None of the doctors here are paper pushers.  We get to enjoy taking care of patients.”

Most primary care doctors—in both the United States and the United Kingdom—aren’t so fortunate, however, and work in environments where rushed schedules, paperwork, and discontent are the norm.