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Novel program addresses looming primary care physician shortage
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A report issued by the Association of American Medical Colleges suggests that although the physician supply is projected to increase modestly between 2015 and 2030, the demand will grow more rapidly. This will result in a shortfall of between 7,300 and 43,100 primary care physicians.
“We’re already short [on primary care physicians], and knowing that the demand for services is going to continue to go up makes it even more imperative that we recruit people into primary care and have the training slots so they can do primary care residencies,” Clif Knight, MD, FAAFP, and AAFP senior vice president, education told Healio Family Medicine in an interview.
Knight referenced a Congressional Budget Office report from earlier this year that was issued 2 months after the Association of American Medical Colleges report. The report stated that if current law remains “generally unchanged,” demand for primary care is projected to rise by 18%, between 2013 and 2023.
“It’s vitally important that we have medical students exposed to primary care and choose primary care,” Knight said.
One initiative providing such exposure and trying to help stave off the pending demand is Primary Care Track, offered at the University of Maryland School of Medicine.
“We realized that in order to get a resident interested in primary care, we first have to get them interested in choosing a primary care residency. And to do that, we need to show them the excitement of primary care early on in medical school,” Richard Colgan, MD, professor, family and community medicine, University of Maryland, and one of the initiative’s principal investigators, told Healio Family Medicine in an interview. “We’re essentially buying facetime. We’re trying to get these students to work alongside primary care physicians and see for themselves that these doctors enjoy what they’re doing.”
In Primary Care Track, students in years 1 and 2 spend one half-day per month shadowing one of more than 100 faculty members who is either a family medicine physician, general internist or general pediatrician. The facilities where the students work with clinicians includeon and off campus locations in a variety of rural and urban settings across Maryland. Students are also given the opportunity to work with these same physicians during years 3 and 4 and attend monthly lectures on primary care topics specific to care.
Students in the program say the mentoring component has been a valuable one.
“The experiences I’ve had with [my mentor] have illuminated many of the socioeconomic issues regarding health care, and allowed me to gain a greater appreciation for primary care,” Abby Goron, who will graduate from medical school in 2020, told Healio Family Medicine. “I’ve learned so much about this particular patient population in Baltimore —there is unfortunately a lot of poverty, low health literacy, drug use, diseases like hypertension and diabetes, and much, much more. It has opened my eyes to the fact that we need extremely patient, caring and kind primary care physicians who are willing to take the time with their patients to be a health care and social justice advocate. This is the type of physician that I aspire to become.”
Gloribel Le, who just finished her third year of medical school, was considering orthopedic medicine, but chose to explore pediatrics, in part because of the program.
“I enjoyed shadowing a pediatrician in a private practice and seeing her relationships with her patients. I also shadowed a family medicine physician during my second year of medical school, where my eyes were opened to how many procedures they do in the family medicine clinic, which I hadn’t realized before.
She added the program also helped her realize “the comfortable lifestyles primary care physicians can have and the happiness and fulfillment they have in their career choice.”
According to Colgan, two-thirds of the program’s 44 graduates this year chose primary care, up from half of the program’s 36 students in 2016.
Knight acknowledged the Primary Care Track could help steer more medical students into primary care and thus, help address the shortage.
“The principles of the approach are spot on to what needs to be done in order to increase the number of primary care physicians,” he said. “That early exposure, especially to good role models, is a really key component. So absolutely, AAFP supports that component of exposing medical students early in their career to strong primary care role models.”
Previous studies have suggested that medical students are steered away from family medicine because the specialty isn’t mentally stimulating enough. Colgan objected to that.
“Those types of comments often come from the uninformed and it’s amazing to me how often physicians in other disciplines will look to dissuade someone from going into primary care when they have no personal knowledge on primary care medicine,” Colgan said.
“It’s very challenging to be a primary care physician,” he continued. “Patients come to us not with a defined disorder, illness or disease, but often just walk into the door and say they don’t feel well. They have a stomachache, they have a chest pain or a headache. A primary care physician’s job is to try and figure out what’s wrong with them: is it biological, is it psychological, is it an emotional problem, or is it something else? You have to be smart, gifted and talented to choose primary care medicine.”
The future doctors that Healio Family Medicine spoke to also seemed undeterred by that previous research that suggested some medical students may be ‘too smart’ to make primary care their specialty.
“I’ve heard people say that,” Kamilia Butler-Peres, another medical student at the University of Maryland, said when asked about the report. “But I’ve also heard many physicians, including specialists and subspecialists, say that primary care can be more challenging than a subspecialty. It requires an ability to recognize a diverse range of medical problems and an understanding of how those problems can affect the entire body.”
“It’s ... disappointing that the primary care specialties have somewhat become jokingly ‘the easy way out,’ because I think they are anything but,” Goron added.
Colgan was adamant that primary care physicians provide valuable contributions to the medical profession, and students entering the field should not be ridiculed.
“[Previous research] has pointed out that societies and cultures that have an adequate number of primary care physicians have better health care outcomes,” he said. “Having an adequately trained primary care workforce means having a society where diseases are better prevented; deaths, [ED] utilization, hospitals and the needs and suffering of Americans could all be dramatically reduced.” – by Janel Miller
For more information: Richard Colgan MD, can be reached via email at rcolgan@som.umaryland.edu
References:
Duchovny N, et al. Projecting Demand for the Services of Primary Care Doctors, Congressional Budget Office, May 2017.
Physician Shortage and Projections, Association of American Medical Colleges, March 2017.
The Primary Care Track: A University of Maryland School of Medicine's Initiative to Improve Health Care Disparities in Maryland, Maryland Medicine; 12/1/2016, Volume 17, Issue 4, p. 30.
Disclosures: Knight is senior vice president of AAFP. Colgan is a staff member at University of Maryland; Goron, Le, and Butler-Peres are students at the University of Maryland.