Wednesday, July 18, 2018
By Dr. G. Richard Olds
About 20,000 students recently graduated from U.S. medical schools. Now, they're beginning the next chapter of their training, as residents.
Yet less than 7,000 will be pursuing careers in primary care. America will be short up to 43,100 primary care physicians by 2030, according to the Association of American Medical Colleges.
Medical schools have a responsibility to help fix this shortfall. They can do so by making primary care more alluring to students.
Primary care physicians are our healthcare system's first line of defense. They diagnose illnesses, help manage chronic conditions, and refer patients to specialists. Without them, patients would get lost in today's byzantine health system.
The shortage of primary care doctors is partially due to concerns over money and status. Specialists are better paid and often involved in prestigious new research.
Between April 2016 and March 2017, physician recruitment firm Merritt Hawkins conducted nearly 3,300 searches for its clients. The average offered to recruit an orthopedic surgeon was $579,000. The average to recruit a family practitioner was less than half that.
The shortage also occurs because U.S. medical school’s faculty are mainly specialists. Surgery departments in U.S. medical schools boast over 15,000 faculty members. Family practice departments have just 5,700 members.
Professors serve as role models to students, many of whom seek to follow in the footsteps of these mentors. Overwhelmingly, that means pursuing a career as a specialist.
Aspiring doctors also train in settings that push them toward specialties, not primary care. Medical students generally train in large teaching hospitals that serve patients who have been referred from primary and secondary care providers. Few students train in small clinics and local doctor's offices.
But most health care -- and almost all primary care -- is delivered outside of the hospital. Americans make 923 million trips to physician offices every year -- and only 130 million to emergency departments. More than half of office visits are to primary care physicians.
So medical students rarely gain enough experience in primary care settings to decide if it's the right career path for them.
These barriers are significant but not insurmountable.
To start, schools could promote primary care as a career. In 2015, the medical school at the University of California, Riverside, partnered with the Desert Regional Medical Center and Desert Healthcare District to launch a new primary care residency program in Palm Springs. UC Riverside also partners with Loma Linda University to offer the Pediatric Primary Care Residency Training Program, which prepares residents for careers in pediatrics and family medicine.
Second, schools could ensure students gain hands-on primary care experience by encouraging them to serve at community clinics. At the University of California, Davis, School of Medicine, for example, nearly nine in ten students volunteer in clinics in underserved communities. As a result, half of UC Davis students picked a primary care residency in 2015.
Third, schools could subsidize tuition for students who commit to primary care careers. At St. George's University, on the Caribbean island of Grenada, our CityDoctors Scholarship program provides grants to students from New York City who agree to return to practice in the city's public hospital system after they graduate. This year, eight students received CityDoctors scholarships worth a total of $1.1 million.
Medical schools must make careers in primary care exciting and affordable for a new generation of physicians.
G. Richard Olds, M.D., is President of St. George's University. He was founding dean of UC Riverside's medical school.