Increasing Primary Care Providers Without Paying Them
by David E. Myles (email author); Monday, January 5th, 2009It almost makes too much sense. Students with more debt should choose higher paying specialties than students with less debt. Therefore, we should reduce the debt load of students to increase the likelihood that they enter primary care fields.
Although this argument is sound, it is not valid because a number of studies have demonstrated that debt level has little, if any, influence on students’ residency and career choices (1). If anything, those with MORE debt may choose primary care residencies more often than those with less debt (2).
While I am not advocating the doubling of tuition and fees of medical school attendance, I do want to ensure that we have enough primary care providers to meet the needs of patients in our current and any reformed healthcare system. Increasing their number will make health care reform more effective and more efficient. The question asked, then, is how set up systems that reproducibly increase the number of medical students choosing careers in primary care.
Reframing the aforementioned findings can help us propose such systems. One way to look at the findings is that is to realize that students choose to enter a primary care field (pediatrics) even at high debt levels. Our task is to find people who are intrinsically interested in pursuing such career paths.
A study published over a decade ago observed that students from rural regions and those who are underrepresented minorities are more likely to pursue primary care and work in environments with relatively less resources, respectively (3). Without spending any money, admissions committees at schools whose mission it is to educate the primary care providers of tomorrow could redouble their efforts to identify such students.
Once again, the challenge appears to be deceptively simple. If our goal is to have increasing numbers of medical students pursuing primary care then we should recruit and train those who want to pursue primary care. Combining these recommendations with ongoing empirically-derived efforts will help us to provide even better care for our patients.
David E. Myles, MS III
Yale University School of Medicine
1. Grover A. When Money Doesn’t Change Everything. Annals of Internal Medicine. 2008; 149 (6): 429-430
2. Jolly P. Medical School Tuition and Young Physician Indebtedness. AAMC. 2004: 1-25
3. Senf JH, et al. A Systematic Analysis of How Medical School Characteristics Relate to Graduates’ Choices of Primary Care Specialties. Academic Medicine. 1997; 72 (6) 524-533.