Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Joy in Primary Care 


Meaningful longitudinal primary care relationships with patients are fulfilling and rewarding. Modeling for trainees that this career path can be gratifying and fun is vital. 

I’m a new primary care attending in my first year of practice after residency. I’ve always enjoyed outpatient medicine, but the more I work independently, the more I understand how my residency schedule didn’t always allow the best parts of outpatient medicine to shine. 


The AAMC projects a shortage of up to 48,000 primary care physicians by 2034, with 83.7 million people in the United States currently living in a designated primary-care health professional shortage area. For the well-being of our patients and our health systems, it’s critical that we inspire trainees to pursue careers in general internal medicine.  


Here are five distinctions between training and everyday practice that have made a difference to me and affirmed my choice of primary care: 


1. Primary care is all about a growth mindset.

Almost every day I’m presented with a problem I haven’t entirely addressed before. My job as a PCP isn’t to know everything for a patient, but to be intimately aware of my limits and understand when and how to ask for help. As a resident, confronting my knowledge gaps felt never-ending and sometimes defeating, and I often craved certainty. As an attending, I have the time and perspective to see these as opportunities to read and interact with colleagues rather than personal deficiencies. A growth mindset is a lot easier to maintain with good sleep and days off.  


2. Covering other clinician’s patients is hard.

As a resident, “cross-coverage” is a consistent part of outpatient time; as an attending, it’s occasional. Interacting primarily with patients I know well has allowed me to switch from giving reactive care to providing proactive care whenever possible. When I do cross cover, I learn from more experienced doctors’ management style.  


3. Care coordinating can be just as critical a skill to develop as a medical knowledge base.

Learning how an office works takes time and relationship building. As a resident, I was less frequently physically in the clinic and was often intimidated by logistics I didn’t understand. As an attending, I get to spend time every day with the staff who know the system better than I do. They make me better at my job. They also leave candy on my desk when I’ve had a long day.  


4. Expanding my panel from sixto 20 visits a day was daunting, but the extra space in my schedule has transformed the way I approach patient care.  

I can boundary- and agenda-set knowing I can defer problems to another time. I can schedule a follow-up to give myself another opportunity to reassess a challenging diagnosis. I can offer more frequent touch points to my most vulnerable patients. As a resident, I often tackled too much because I knew my openings to see people were limited. As an attending, I’ve learned that spreading out care over time is sometimes more manageable both for the patient and for physicians. 


5. Committing to my role has made my patients more committed to me. 

As a resident, I was often asked, “When are you leaving?” As an attending, my relationships with patients have no expiration date. I’ve started seeing every member of a family of six and was invited to three Thanksgivings. I’ve experienced the incredible honor of a mother asking me to fit in an appointment with her child. There’s almost no specialty that can offer that type of expansive and tender view into people’s lives. In residency I got a taste of that, but as an attending, I am energized by it each day.  


If you or your trainees are undecided about your career path, ask your mentors/talk about what aspects of their/your job fulfill them/you now that they wouldn’t have predicted while in training. If you’re a resident interested in primary care, we need you!  









This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.