Published in the November 2015 AAMC Reporter
By Whitney L.J. Howell
With a looming doctor shortage, several medical schools are launching programs and curricula to help encourage students to pursue primary care careers. The hope is that students will have more time to develop a career interest in disciplines such as family medicine, internal medicine, and general pediatrics.
According to an AAMC study released in March, the United States will face a shortage of up to 90,000 physicians by 2025, with a deficit of up to 31,000 primary care doctors. Much of the shortage can be attributed to a growing and aging population that will require more of both primary and specialty care.
“We know fewer trainees are going into [internal medicine], but we’ve been working to improve the lifestyle and reimbursement for [internal medicine] and, more broadly, primary care,” said Ann Nattinger, MD, general internal medicine (GIM) chief for the Medical College of Wisconsin (MCW). “But improving reimbursement and redesigning the field won’t do anything without students. We must have a pipeline of bright, motivated medical students and residents.”
Encouraging primary care
Rowan University Cooper Medical School opened doors to its first medical school class in 2011. Already, institution leaders are focusing on promoting primary care and augmenting the number of providers.
In July, Cooper received a $1.75 million grant from the Health Resources and Services Administration Primary Care Training and Enhancement program to bolster primary care training. According to Vice Dean Anne Reboli, MD, funding will support faculty development, as well as a new three-year, competency-based curriculum.
Within the curriculum, which will begin in 2016, students will train in patient-centered medical homes (PCMHs) with a variety of primary care providers.
“We’re convinced students need the ability to respect and understand the role of other providers,” Reboli said.
Cooper students also run a primary care clinic where they learn about barriers to care and provide services under faculty supervision. The clinic operates four days a week, and each student works three hours weekly.
At Duke University School of Medicine, students who are interested in primary care can enroll in the Primary Care Leadership Track (PCLT), which increases exposure to primary care. During clinical training, students follow the same patients throughout the year and complete coursework in health literacy and community engagement. Students who enroll in PCLT sign a letter of intent to pursue primary care and receive a scholarship of $10,000 annually. If students do not remain in primary care, the scholarship reverts to a loan.
Students at the Texas Tech University Health Sciences Center can choose to complete medical school in three years through the Family Medicine Accelerated Track (FMAT), enabling graduates to enter the workforce a year earlier and save a year of tuition. Students also receive scholarship support. The program leads directly to a family medicine residency at one of three Texas Tech programs in the state. According to FMAT reports, more than 90 percent of family medicine residents continue practicing in primary care.
In addition to efforts originating at individual medical schools, the Society for General Internal Medicine (SGIM) is encouraging more students to enter primary care with its ProudtobeGIM campaign, which launched in October. According to MCW’s Nattinger, a ProudtobeGIM’s project leader, the program aims to make primary care more attractive. Twenty medical schools applied for funding, and six were selected to create and test innovative methods to increase GIM interest among first- and second-year students.
“We want to learn what works with different kinds of students so we’re ensuring we can speak to a broad group of medical students across the country,” Nattinger said.
Medical speed dating
It is an exciting time for primary care, noted Paul O’Rourke, MD, MPH, GIM fellow at Johns Hopkins Medicine and ProudtobeGIM liaison. The Affordable Care Act, new payment models, and the advent of PCMHs provide opportunities for medical students to observe how primary care physicians are contributing to delivery reforms and make it vital to bolster the number of GIM doctors.
In a novel approach to expanding the physician pipeline, Johns Hopkins used a speed-dating model. On Oct. 30, students rotated through five groups of primary care providers—faculty and roughly 25 alumni community physicians—to discuss five topics: GIM clinical opportunities; GIM research; leadership, advocacy, and public health; medical education; and work-life balance. The event offered opportunities for interactive student-provider discussions about life as a primary care physician.
In addition, O’Rourke said, the school is designing a mentorship program to pair faculty and students with similar interests. Alongside three annual social events, students will have ongoing chances to learn from faculty, seeing how primary care providers can improve outcomes and lower costs.
“We’re passionate about GIM and feel honored to be in this position as the quarterbacks of patient care,” O’Rourke said. “We have a unique role to be there for patients during crises and minor ailments.”
