As a medical student and now family physician resident at UC Davis, I’ve attended numerous medical conferences over the past several years, and the same theme keeps coming up over and over again: “We need to find a way to market and sell Primary Care!” “We need to make Primary Care sexy!” Much like Grey’s Anatomy has made surgery sexy, I’ve even heard proposals for a Primary Care or Family Medicine-based reality show.
Indeed, the need for primary care has never been more recognized. Current evidence suggests that health care systems that focus on primary care provide greater access to care, higher quality care, and do so at lower costs.
Yet there is a critical shortage of primary care doctors: According to the Association of American Medical Colleges (AAMC), the US is projected to have a shortage of approximately 21,000 primary care professionals in 2015 (and others have estimated shortages of 40,000 by 2025 given overall population growth and a growing elderly population).
This shortage is most likely to disproportionately affect vulnerable populations, like the elderly, those who rely on community health centers, and people in rural or poor urban communities who have traditionally been underserved. In California, the population of elderly is expected to increase by 112 percent over the next ten years. And 45 percent of rural Californians live in areas where there is a primary care shortage, making the need for primary care services particularly crucial.
While there is great need for expanding the primary care workforce in California, the time to ‘market’ primary care to future physicians is likely as ripe as it ever will be. With the Obama administration’s recent commitment of $168 million to create more residency slots to train more than 500 new primary care physicians during the next five years and an additional $5 million for states to expand their primary care workforces by 10 percent to 25 percent during the next 10 years, the financial barriers to workforce issues are for the first time being addressed.
Conversations about the importance of primary care are cropping up everywhere- from politicians’ platforms to mainstream media to the agenda of prominent health care organizations. In fact, the American Medical Association, which represents physicians of all specialties, stepped up to advocate that more medical students and residents choose a career in primary care. At the recent 2010 Annual meeting of the AMA House of Delegates in June, they announced their plans to promote training in the patient-centered medical home.
While the funding, the number of residency positions, and the lingo shockingly appear to be heading in the right direction for primary care for the first time, will all of this change the number of students who actually choose a career in primary care?
There are numerous ways that medical students, residents, and physicians can impact the pipeline that steers future physicians into a primary care career:
Before Medical School
Studies have consistently shown that this is the area offering the most bang for our buck. Those who enter medical school expressing an interest in primary care are highly likely to continue with this pursuit. And, those that come from rural or underserved backgrounds are most likely to practice in a rural or underserved area, where primary care physicians are needed the most. Those with strong community service backgrounds and low income expectations are also likely to choose a career in primary care.
So, how can primary care physicians aid in bringing these types of students into medical school?
-Early exposure. Medical students, residents, and primary care physicians should mentor pre-med students and even high school students; those civic minded individuals from rural or underserved backgrounds might not have considered that a career in medicine is even possible; with the right mentor, they just might!
-Primary care doctors should get involved in the selection committee that chooses who comes into medical school
During Medical School
Studies have shown that the first two years is critical (before students even start the wards). While many students consider primary care as a career choice early in their undergraduate experience, this number drops significantly during the second year of their curriculum. The most cited reasons by students for not choosing a career in family medicine in particular include prestige, income, and the breadth of knowledge required.
This is where exposure becomes critical and this is where we, as practicing residents and physicians, have the opportunity to make primary care truly sexy and sell it.
Exposure, exposure, exposure. Exposure to underserved populations, community health centers, families and communities and faculty involved in Family and Community Medicine is key. In fact, four new medical schools that have recently opened their doors (last fall) are embracing this philosophy.
Medical Students at the Commonwealth Medical College in Scranton, PA, are assigned a ‘continuity mentor’ (either a Family Practitioner or General Internist ) and a family that they follow through all four years of medical school, visiting their families’ homes to learn about the socioeconomic context of health care and the health care system.
Medical students at Florida International University are exposed to a team-based approach: they are partnered with nursing, social work, and public health students and visit households in medically undeserved, multicultural communities twice a month, working as a team to provide patient care. And FIU has even committed to having a 10:1 student to family medicine faculty member ratio, increasing medical school students’ exposure to family medicine and primary care.
Innovations in care delivery. The patient centered medical home is perhaps one of the most brilliant marketing tools at our fingertips. With its implications for improved quality and access to care and for restructuring physician reimbursement, it is the ‘buzz’ word we now hear even politicians and mainstream media using in the ongoing health care debate. And, family medicine and primary care is at the forefront of this conversation. It’s time we use the PCMH to our advantage and sell it to medical students who are excited to be involved in this cutting-edge model of care delivery.
Other avenues. With national organizations like the American Academy of Family Physicians (AAFP), Society of Teachers of Family Medicine (STFM), and the Robert Graham Center, students have opportunities to get involved in leadership, health care policy and advocacy, and research, advocating for their patients not only at the individual level but also at the policy level. Medical Schools and Residency programs should embrace students’ and residents’ interests and help design opportunities and tracks that appeal to those interested in primary care.
With fellowships in Obstetrics, Sports Medicine, Preventive Medicine, and Geriatrics, Family Medicine and primary care docs have opportunities to embrace areas they are particularly passionate about.
After Medical School
We must be advocates for policies that forgive student loans, offer scholarships to students, and reduce the salary gap between primary care doctors and specialty care doctors. Such methods include expanding the National Health Services Corps (NHSC) and advocating that public and private payers develop enhanced funding and related incentives that allow physicians to practice in rural and other underserved areas.
While the projected shortage of primary care physicians appears quite daunting, we are actually at a unique crossroads in health care reform history where the financial, political, and cultural winds of change favor primary care. We must help fuel the future direction of our physician workforce by working with high school students, giving students the opportunities to experience longitudinal care of families in a team-based community setting, exposing students to policy and advocacy, touting opportunities to master OB or be on the forefront of innovative models of care delivery.
Primary Care is indeed a sexy field. We must thus make efforts to sell it that way.
Randi Sokol, MD/MPH is a second year Resident at UC-Davis Family & Community Medicine Program. Her opinions expressed here are her own and do not represent UC Davis.
