Ashar Asif

Primary care is the lowest-paid physician specialty. Wanna see what my day looked like today? And somehow I’m constantly doing specialist work because patients can’t afford the specialist, don’t want to go, or literally can’t get an appointment for months. People on Twitter keep telling me AI is going to automate primary care. Good luck. I'm more focused on how to get paid more appropriately for all the things that I'm doing. Here was my day today. Nothing unusual. Just an average day in primary care: 1. High cholesterol follow-up + weight-loss medication management. 2. “Annual physical.” Found a suspicious skin lesion concerning for cancer. Also noticed word-finding difficulty → started a dementia workup. 3. Hospital follow-up after a recent heart attack complicated by cardiogenic shock. 4. New dysphagia + anxiety → started workup. 5. “Annual physical.” Also menopause + hormone replacement therapy management. 6. “Annual physical.” Also follow-up after discharge from an inpatient psychiatric hospitalization. 7. 72-year-old with unintentional weight loss + coughing up blood. Concern for a new cancer → started the workup. 8. “Annual physical.” Also severe agoraphobia. He has essentially isolated himself on his property in a bunker for two years. We talked about how to start getting him back into society. 9. Annual physical. An actual annual physical! 10. “Annual physical.” Also managing multiple side effects from chemotherapy. 11. “Annual physical.” Found another suspicious skin lesion. Also started weight-loss medication and hypertension treatment. 12. “Annual physical.” Also started treatment for alcohol use disorder and connected the patient with resources. 13. “Annual physical.” Also discussed pregnancy, a recent miscarriage, and the anxiety and stress surrounding it. 14. Annual physical for a healthy guy who wanted to nerd out with me over additional biomarkers. 15. Psychiatric medication issue because the patient can’t get into psychiatry. Concern for a manic/bipolar episode + lab follow-up. 16. “Annual physical.” Also anxiety treatment, weight-loss medication management, and hypertension treatment. 17. Pulmonary fibrosis with worsening shortness of breath and anxiety. Discussed end-of-life wishes. Signed an out-of-hospital DNR and arranged additional support. 18. STI visit and treatment. 19. Type 1 diabetes + insulin pump management because the patient can’t get into endocrinology. So now primary care is managing it. 20. Virtual visit for a newly diagnosed Parkinson’s patient. Starting treatment because neurology is booked out for the next NINE MONTHS. That was one day. Dermatology. Cardiology. Psychiatry. Oncology. Endocrinology. Neurology. Women’s health. Addiction medicine. Palliative care. And buried underneath all of it: prevention, hypertension, cholesterol, obesity, diabetes, anxiety, medications, labs, and the actual annual physicals. Primary care increasingly feels like the specialty that absorbs whatever the rest of the healthcare system cannot handle. We’re paid less because what we do is labeled “primary.” There’s nothing primary about it. So yes, AI will absolutely change my job. I hope it does. There is plenty of administrative garbage I’d love to automate. But replacing the person who has to walk into 20 completely different rooms, figure out what actually matters, recognize what doesn't fit, know when something is dangerous, manage what the patient can't get managed elsewhere, and then immediately reset for the next completely unrelated problem? Good luck automating that day. Yes some of it can be automated ..but the majority..not anytime soon.