What exactly does a GP do and why do we need them?

I’m starting this thread because I’ve been wondering about the actual role and authority of primary care physicians.
It feels like most of them just pass people off to specialists without even attempting to tackle the issue themselves, even though they know their own patients way better than some specialist ever could.
For instance, if I go to my doctor complaining about kidney pain, they just hand me a referral for a urologist or a nephrologist. By the time I actually see the specialist and get all the tests done, I could practically die and be reincarnated.
Honestly, at this rate, you might be better off skipping the GP entirely and going straight to the specific specialist you think you need, or just hitting the main intake desk at a hospital like Mayo Clinic. They'd probably send you exactly where they want you to go, much like how they're planning to route everyone once the new hospital wing is finished at Ribbon.
I know there are doctors out there who won't even give you a referral, even when it's obvious that the medication and tests they ordered aren't doing a thing, mostly because they're trying to nickel and dime every single expense.
In my opinion, a primary care doctor should run basic tests and try some initial treatment first; if that doesn't work, then—and only then—should they be handing out those specialist referrals.
That would definitely help clear up the massive backlogs at specialist offices, since it seems like some doctors are handing out referrals like they're candy.
Older folks always say that GPs used to know so much more and could actually resolve so many medical issues back in the day. It leaves people with the impression that today's doctors either don't want to or simply don't know how.
I really don't mean to offend anyone or belittle anyone here, especially doctors, because I have immense respect for them—it's an incredibly tough road to become a physician. I'm just genuinely confused by how things work.

Medicine used to be a much narrower field, I suppose... as our society evolved, job specialization became inevitable because no single person can possibly master the sheer volume of information available today. Doctors have to specialize in niche areas simply because there aren't enough hours in the day, nor do we live long enough to absorb all that knowledge...

Of course, people are different, which means there will always be better and worse physicians. It's also just not common for everyone to see the same primary care doctor their entire lives, for various reasons.

From what I've seen, primary care doctors often try to handle minor issues themselves first, but as soon as they spot red flags, they refer you to a specialist, which is actually a great thing 👍 because it minimizes the risk of an incorrect diagnosis or something far worse. So many illnesses present with similar symptoms that it would be impossible to distinguish them without specific testing and specialized expertise.

Tom Hanks said:I am starting this thread because I want to understand the actual role and authority of a primary care physician.
Most of them simply refer patients to specialists without attempting to address the issue themselves, even though they know their own patients much better than a specialist ever could.
For instance, if I see my doctor complaining about kidney pain, he just hands me a referral for a urologist or a nephrologist. By the time I actually see the specialist and finish all the testing, I could practically die and be reborn.
It seems easier to just bypass the GP entirely and go straight to a specialist or head to the main intake desk at a major hospital like Mayo Clinic; they would likely route you exactly where they intend to send everyone once their new facility is completed.
I am aware there are doctors who refuse to provide referrals even when it is clear that the current treatment and tests aren't working, essentially penny-pinching on every single step.
In my view, a primary care doctor should run basic tests and prescribe initial medication, and if those fail to show results, they should then provide the referral to a specialist.
This approach would certainly reduce wait times for specialists, as many doctors currently hand out referrals far too indiscriminately.
Older generations often remark that primary care doctors used to possess much deeper knowledge and resolved many more medical issues than they do today. The impression is that modern doctors either lack the desire or the ability to do so.
I have no intention of insulting or belittling anyone, especially physicians, whom I respect deeply given how difficult the path to becoming a doctor is. It is simply that certain aspects of the system remain unclear to me.

Remember what a famous 94-year-old doctor from San Diego once said:
Quoting him: "Today's doctors are excellent theorists, but they are no practitioners at all." I believe that summarizes everything perfectly.

shadowfox75 said:Just remember what this legendary doctor from San Diego—who's 94 now—used to say.
I'll quote him directly: "The doctors we see today are great at the theory, sure, but they don't have a clue when it comes to actual practice." I think that pretty much sums up the situation for you.

It's the same old story. Always is.

Man, you really run into all kinds of GPs out there. My doctor is one of those awesome ones who almost always tries to handle things right then and there without immediately sending you off to some specialist or ordering a mountain of endless tests. He’s even got an ultrasound machine and a little mini-lab set up in his office, so he can just knock out the basic stuff himself. I know other docs too—even with way fewer tools on hand—who are absolute legends, but honestly, most of them usually spent some serious time working in a big hospital first, which is where they get that invaluable, hands-on experience.
The thing is, doctors who jump straight from med school into a small clinic know all the textbook theory, sure, but they lack that real-world foundation. So, they end up passing patients off to specialists because they aren't totally confident in what they know, which I guess is their way of playing it safe to avoid making mistakes.
It’s honestly pretty wild when a doctor doesn't even know how to give a simple injection; it really says a lot about the quality of medical education here in the States. And it’s not just a medical school thing, either—most colleges in the US seem to be so heavy on theoretical knowledge that once you actually get into the field, you realize you have no idea how to apply it to real life.

I honestly think a GP’s main job should be prevention. They should handle the minor stuff and figure out who actually needs to see a specialist and when.
I mean, what is a primary care doctor even supposed to do if someone has kidney pain? Aside from ordering labs and sending them off to a specialist, there isn't much.

It’s honestly such a relief when you stumble upon someone who actually knows their way around an ear. Most of the time, if you have even a minor laceration that needs stitches, they just shuffle you off to surgery because they don't have the skills to do it themselves. Honestly, half the staff can't even handle a basic IV injection. It feels like most people working there are just glorified administrative clerks meant for cranking out prescriptions and paperwork rather than actually practicing medicine.🤣

lonefox7 said:It is unacceptable for a doctor to be unable to perform something like an injection—it speaks volumes about the quality of education in our country. This isn't just limited to medicine, either; most of our universities focus heavily on theoretical knowledge, which turns out to be insufficient once you actually need to apply it in a practical setting.

Administering injections or similar minor procedures is actually the least of our concerns—any doctor can pick that up in fifteen minutes, provided they do it a few times themselves.

The far more pressing issue in America is the structure of our educational system and how we teach and test proficiency. Specifically, during medical school, students are fed massive amounts of theory and raw data, yet they are taught very few clinical algorithms. Algorithms are precisely what you rely on once you enter practice—they are the tools that streamline diagnosis. Unfortunately, here, those logical frameworks are only learned through trial and error later on in one's career. In my view, that is the fundamental flaw in American medicine, at least regarding the direct physician-patient relationship. Because doctors lack these ingrained diagnostic algorithms—despite having undeniable knowledge—general practitioners often end up ordering unnecessary tests, referring patients to specialists prematurely, or prescribing broad-spectrum medications instead of performing a deep, investigative dive into the patient's actual needs. Of course, much of this is driven by a desire to protect both the doctor and the patient from liability. The byproduct, however, is astronomical costs within local clinics and hospitals, which ultimately burdens the entire healthcare system. Generally speaking, in Western nations—particularly the Nordic countries and the United Kingdom—general practitioners are among the most respected specialists. They handle a much higher volume of diagnostics than our doctors do; while they certainly benefit from better working conditions and perhaps a stronger foundational curriculum, they still serve as the primary point of contact globally. It falls on them to identify everything from psychosomatic issues and hypochondria to emergency interventions and brain tumors.

So... I just finished my clinical rotation in Family Medicine...
I have to admit, I walked away genuinely impressed by the sheer depth of knowledge my preceptor possessed. She was handling everything herself—minor surgical procedures, home visits, wound irrigation—and she did it all with incredible skill. There was this one patient in the clinic where she nailed the diagnosis, only for some arrogant specialist to scoff at her, basically implying, "What does a primary care physician know?" But she didn't back down; she actually called the Chief of Department's office to demand a second look. In the end, that condescending specialist had to eat humble pie and apologize because she was, quite simply, right.
The real issue here (and it’s a mindset deeply ingrained in medical students too) is this pervasive myth that Family Medicine is just a glorified job of writing referrals.
But over the last month, I’ve seen firsthand how demanding and complex this field actually is. While a nephrologist might focus on one narrow niche, a family practitioner has to manage the whole human being—and usually without a mountain of extra diagnostic tests at their disposal.

Now, regarding what I might actually specialize in... out of everything I've shadowed so far, Family Medicine has made the strongest impression on me. Except for one glaring thing... the endless, soul-crushing paperwork. It’s brutal.
Working with patients is wonderful, and there’s a genuine intellectual thrill in treating the entire person rather than just a single organ system. But then, a parent walks in with a three-year-old suffering from tonsillitis... you do a quick exam, see the exudative tonsils, prescribe the antibiotics... and then you spend three times longer filling out the paperwork for the parent's sick leave. Honestly, who is the crazy one here?
In my opinion, being a primary care physician—especially if you're practicing outside of a major metro area like New York or Chicago—is much harder than being a hospital specialist who can just call for a consult every time a problem gets complicated. In the United Kingdom, GPs are top-tier... their knowledge base is massive; they even handle almost all prenatal care, barring the high-risk cases.

I’m bumping this thread because I honestly feel like primary care physicians need much better training; my own doctor missed the mark on my diagnosis a few times, and if I had just gone straight to the hospital,
I wouldn't have been left feeling totally dismissed by her words, which really just served to scare me unnecessarily.

I’ve also heard from quite a few people that when dealing with an acute case of otitis externa caused by fungi, GPs often prescribe things like Maxitrol,
which is actually the last thing you want for a fungal infection since the antibiotics and steroids in those drops act like fuel for the fire, making the fungus bloom even more—instead, the ear should be flushed
with a 3% Boric acid solution followed by Canesten drops; if there’s heavy fungal buildup, they really ought to be referring the patient to an ENT, but there are so many other ways
they mess this up... they really should be able to handle these minor issues successfully, and while I'm not saying everyone is incompetent, I've certainly heard enough horror stories to know it's an issue.

Sometimes a quick search online can clarify what kind of infection you're actually dealing with, and they certainly have medical manuals available for whenever they find themselves out of their depth.

https://i.postimg.cc/VkFpWztx/128732...46197104-n.jpg

I recently visited an ENT specialist, and the doctor was incredibly aggressive while cleaning my ears with a swab; the pain started almost immediately as I walked out of the office, and it just kept getting worse every day. I eventually went back to my GP, who diagnosed bilateral otitis externa and only gave me Boric acid, though I later had to call back to ask for Maxitrol because the boric acid wasn't doing a thing;
that stuff is really meant for milder irritations or just cleaning purposes, whereas my bacterial infection was caused by physical trauma and scratching, so Maxitrol
worked almost instantly since the corticosteroids tackle inflammation so fast, especially since the canal was already starting to close up (I won't name the specific ENT specialist involved).

To be honest, even the specialists haven't been particularly helpful to me; twice now, they've actually made my inflammation worse by being way too rough during the cleaning process and causing tiny lacerations.

A lot of people complain that their GPs refuse to write referrals to specialists, but mine always gives them to me regardless of where I want to go, or at least if I insist on it.
Otherwise, the specialists don't offer much help either; I mean, the ER is the only place that truly matters when things get dire, and I've had a couple of those "barely survived" moments, but beyond that,
it's pretty much useless.

If you ask me, primary care doctors have basically turned into glorified administrative clerks. According to Medicare guidelines, they’re supposed to limit the number of referrals they write and try to handle everything in-house. But let's be real—they don't always have the right equipment or specialized training. So, what happens? Treatment drags on forever, and you end up wasting precious time without seeing any actual results. Then, once things get serious, they just tell you to head to the ER. From there, specialists take over and finally give you the right meds, but by then, the condition has already spiraled. Meanwhile, you see pharma reps swinging by offices every single day, practically handing out perks to doctors... It's a mess. The whole system is inefficient, corrupt, overpriced, and honestly unsustainable in the long run.
Get ready for the American healthcare model—where the quality of care depends entirely on how much cash you're dropping. This outdated socialized model is clearly on its last legs...

feralbear26 said:If you ask me, primary care doctors have basically turned into glorified administrative clerks. According to Medicare guidelines, they’re supposed to limit the number of referrals they write and try to handle everything in-house. But let's be real—they don't always have the right equipment or specialized training. So, what happens? Treatment drags on forever, and you end up wasting precious time without seeing any actual results. Then, once things get serious, they just tell you to head to the ER. From there, specialists take over and finally give you the right meds, but by then, the condition has already spiraled. Meanwhile, you see pharma reps swinging by offices every single day, practically handing out perks to doctors... It's a mess. The whole system is inefficient, corrupt, overpriced, and honestly unsustainable in the long run.
Get ready for the American healthcare model—where the quality of care depends entirely on how much cash you're dropping. This outdated socialized model is clearly on its last legs...

👍
That’s exactly it!
I honestly believe we're going to see the number of primary care physicians drop by about 60 to 90% very soon.
Instead, there will be some kind of program or app that you simply download onto your computer or smartphone. You'll log in using your Medicare card, "chat" with the computer, explain what’s bothering you and what symptoms you're feeling, and maybe even upload a few photos or a quick video.

You’ll even have the freedom to choose the "persona" of your digital doctor ( )

The "doctor" will then simply refer you to a specialized digital specialist, and if it turns out to be something serious, you'll finally find yourself in the hands of a real, human specialist. Even if it sounds completely wild, isn't this just the inevitable future of medicine?

Of course, there will still be the option to visit a GP for a traditional checkup—but you can bet it'll come with a $50 surcharge for a mere fifteen-minute appointment. 😁
I suppose the older generations and those who aren't exactly tech-savvy will likely stick to the old ways and continue showing up for in-person visits, just like they do now.

Private practice can be a gold mine. We’re talking anywhere from $40,000 to $70,000 extra a year. When you stack that up against a surgeon making maybe $10,000, the gap is pretty massive. Still, general practice isn't for everyone. It's drowning in paperwork, and you actually have to be decent at dealing with people.

What kind of surgeon actually makes $2333??? None of them.

A total mess?
It’s like trying to find a specialist you absolutely need, yet somehow they’re impossible to actually reach.
Last time I tried, I had to call exactly 44 times before someone finally deigned to pick up the phone.

It was either a busy signal or just ringing until I lost my mind.

Only 44 times? I’ve had to call 69 times just to get someone to pick up the phone!

Now, I'm not trying to make excuses for the nurses, but their workload has exploded since the pandemic. They aren't just handling paperwork anymore; they're basically acting as orderlies too. They have to go out, grab the patient, bring them in, and lock the doors... It's overwhelming. I remember being in my hospital bed, nursing a wound after surgery, while the phone just kept ringing and ringing. People were getting angry because nobody was answering, but how can they when they're busy performing two different jobs at once?
I honestly think the real issue lies with the doctors. There was a time when they would actually answer the phone themselves if the nurse was tied up, especially if they didn't have a patient right in front of them. In my local clinic, we've cycled through five different doctors in a very short period, and all of them just sit there waiting for a nurse to bring the patient to them. God forbid they actually get up to fetch someone or take a quick call—it just doesn't happen.

Walter Thomas18 said:What kind of surgeon actually makes $2333??? None of them.

Even a surgical resident isn't seeing money like that. Maybe
the guy just got his math mixed up somewhere.-ish

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dustymarlin10 said:A total mess?
It’s like trying to find a specialist you absolutely need, yet somehow they’re impossible to actually reach.
Last time I tried, I had to call exactly 44 times before someone finally deigned to pick up the phone.

It was either a busy signal or just ringing until I lost my mind.

rustymason82 said:Only 44 times? I’ve had to call 69 times just to get someone to pick up the phone!

Now, I'm not trying to make excuses for the nurses, but their workload has exploded since the pandemic. They aren't just handling paperwork anymore; they're basically acting as orderlies too. They have to go out, grab the patient, bring them in, and lock the doors... It's overwhelming. I remember being in my hospital bed, nursing a wound after surgery, while the phone just kept ringing and ringing. People were getting angry because nobody was answering, but how can they when they're busy performing two different jobs at once?
I honestly think the real issue lies with the doctors. There was a time when they would actually answer the phone themselves if the nurse was tied up, especially if they didn't have a patient right in front of them. In my local clinic, we've cycled through five different doctors in a very short period, and all of them just sit there waiting for a nurse to bring the patient to them. God forbid they actually get up to fetch someone or take a quick call—it just doesn't happen.

I’ve just given up on calling altogether. My doctor's office has a dedicated line for prescriptions, referrals, and messages, but for anything else, you have to show up in person. Theoretically, one should make an appointment, but I just show up. They have to see me.

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mellowskipper said:I’ve just given up on calling altogether. My doctor's office has a dedicated line for prescriptions, referrals, and messages, but for anything else, you have to show up in person. Theoretically, one should make an appointment, but I just show up. They have to see me.

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Mine won't even acknowledge your existence unless you call first.

I’ve got an incredible primary care physician. She’s a brilliant diagnostician, actually picks up her phone and answers emails, and handles just about everything herself. Like people have mentioned in previous threads, family doctors used to take a much more hands-on approach to managing things. That’s true, I suppose, but back then, modern diagnostic tools weren't nearly as accessible, and you didn't have the constant threat of malpractice lawsuits hanging over your head. If a GP tried to manage something like a chronic headache today without immediately ordering a battery of expensive scans, they’d probably be crucified by the medical board.
The whole point of family medicine should be having a doctor who actually knows you—your entire medical history, your lifestyle, the context of your life. But unfortunately, it feels like GPs have been forced to become nothing more than administrative clerks. They're mostly held hostage by Medicare. For instance, if a doctor prescribes a specific medication that is clearly best for the patient, but it doesn't fall under certain Medicare coverage guidelines, that doctor ends up getting penalized.