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I think a reason a perception of lazy and uninterested doctors you have to fight with in order to get (the correct) treatment sometimes persist is because the first point of contact for many are GPs and GPs often are the bottom of the barrel of doctors and the most jaded and working under unreasonable time constraints since they act as gate keepers to the rest of the medical system.
Once you actually meet a specialist its like another world. People are (generally) interested, competent and trying to help.
Competent and sympathetic GPs of course do exist but many (most in my impression honestly) really are quite bad, people who either couldn't hack it elsewhere, incompetent immigrants of dubious credentials and people who've just checked out. If anyone's on the AI chopping block it's these guys.
If thats who you're mostly interacting with then what is your impression going to be?
I resent being called out specifically in this manner /s
Thankfully standardized testing indicates I am above average in my equivalent cohort of GMC registered doctors.
GP, now that's going to vary from place to place. But I know the ones in the UK are severely overworked and the official amount of time allocated per patient can be as low as ten minutes, 15 is generous. Even if they would love to take their time, they simply don't have it, and they are forced to implicitly reallocate from the clear-cut cases to the ones who really need it. I would love to defend them against accusations of being bottom-barrel doctors, since someone needs to do their job, but let's just say that with my MSRA score if I had wanted to be a GP I'd be one already, instead of being strung along with further rounds of psych placements. It's hard work, with additional medicolegal risk from seeing such an undifferentiated patient pool. You have the stress of this seemingly relatively clearcut diagnosis being the one that sinks you, or at least puts you through the GMC wringer. However, GP is a great option for those unwilling to take the bullshit that is UK speciality training. Just 2 years. A great qualification if you want to flee to fairer pastures. More scope for private practise, and you can quickly make a name for yourself, even if it's by being just better than the awful ones.
In India, any doctor post MBBS is a GP. It's not a protected specialization like in the UK. And anyone worth their salt will join the rat race in an endeavor not to stay that way. However they don't fill the same niche as gatekeepers as in the UK, patients will usually book appointments with the specialist they (think) they need, or be summarily referred to one. The first port of call for most is a General Medicine doctor (or a super specialist who still sees such cases), and that only comes after a competitive 4 year MD.
Elsewhere? Can't comment. Maybe @Throwaway05 might have something to add. Or @Pigeon from even further afield.
Being an excellent PCP is possibly the most difficult and cognitively demanding job in medicine. On top of that pay is shit, prestige is shit, so great people don't go into it but great people are needed.
Corporate pressure and increasing health problems means they have less time with patients but more to do than ever before.
It's a mess and I understand why patients feel mistreated but they also have no idea whats going on.
As for the specifics in the U.S. IM or FM can be a PCP after completing a relevant residency, with (some?) states having a process for being a "GP" with more limited scope of practice after completing certain levels of residency.
The U.S. is weird because all docs can technically do anything in medicine (unrestricted practice) but getting permission to do that in a particular facility, malpractice insurance, and getting patient's insurance to cover what you do is all complicated. Certain kinds of ethically challenged people manage.
In the UK, the pay is thankfully not shit. Well, by your standards (and mine) the pay for most doctors is trash, but GPs reach those hallowed plateaus faster than other fuckers slogging through 7 years of training.
I think the Indian system is quite similar to the US. I know of scenarios where there are legal requirements, such as it taking a psychiatrist to prescribe stimulants, but it's a combination of getting no
bitchespatients and the medicolegal concerns you mentioned that prevents anyone from doing just about anything.I have heard some stories about the antics of my colleagues in more rural areas. I can't relay them on a public forum without contacting my lawyer first, even if I'm not involved. It gets that bad.
It's not unreasonable for a PCP to make 180-220 a year. That's a lot of money in comparison to most jobs, but when the surgical sub specialist is making 600-800.....people follow incentives.
Note: We have orders of magnitude more doctors in primary care than the sexy big number specialties.
How expensive is malpractice insurance? Does it differ between the two types of doctor? How many more years/loans does it take? How many more hours of work a week is it?
Not rhetorical questions, I'm curious and have no idea.
Malpractice is heavily dependent on state and specialty, can be as low as 5k-10k or as high as well into six figures (OB). Some states have caps on malpractice payouts, some everyone get sued constantly.
Loans are for 4 years undergrad + 4 years of medical school. After that you get paid while working 60-80+ hours a week (but the pay is 50-70) while in residency. Residency lasts like 3-7 years depending on the speciality, and to do some disciplines (like Cardiology) you have to do additional years of poor pay training on top of the residency.
Once an attending most jobs are 40-60 hours a week but some stay higher than that. Depending on the field you may also work weekends, nights, holidays, 24+ hour shifts, 2 weeks without a day off etc. even as a senior doctor.
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We don't get many Indian doctors here, it's mostly middle eastern ones and some from eastern Europe. It's usually the middle eastern ones that are the problem, with the Persians being a big exception.
The funny thing is that immigrants with specialisations are easily as good as the natives, and often better, while their GP co-ethnics are mindbogglingly incompetent.
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