The Medical Education Futures Study Blog

State by state a health care service crisis has emerged. There are not enough primary care physicians to care for the people in our communities. Providing health insurance to all will not address the problem. Insurance will not suffice when there are not enough primary care physicians to provide the needed care.

The short supply of primary care physicians has been caused by a long term decline in the numbers of students choosing careers in primary care. The primary care specialties of Family Medicine, general Internal Medicine and general Pediatrics have each experienced a decline. The deans of most medical school hide this issue by telling the public that they graduate sufficient numbers of graduates to the primary care specialties. By counting all students who choose careers in Family Medicine, Internal Medicine and Pediatrics (some even include students choosing OB/GYN) to their primary care head count, the deans and the organizations that represent them have misled the public.

For decades, a growing percentage of those entering Internal Medicine and Pediatric residency programs have added fellowship training to their preparation so they can practice in a sub-specialty field when they enter practice. Currently, only 10% of those choosing Internal Medicine residency training will practice as a primary care physician. In Pediatrics 65% of the graduates of a residency programs will practice in primary care

The deans respond to their critics by claiming that they are not responsible for the choices of their graduates. They argue that it is the marketplace and not the medical school that is responsible. Their graduates choose sub-specialties because they will earn a substantially higher income as a sub-specialist.

No doubt the marketplace plays a role but so do the deans and the leadership of their medical schools. At a recent meeting of the Society of Teachers of Family Medicine: NorthEast Region in Baltimore, MD, a series of speakers addressed these issues. Representatives from Jefferson Medical Center, Boston University, the National Association of Community Health Centers and others provided a compelling response to the deans. In sum their data indicates that when a medical school creates a program that selects and supports students with an interest in primary care and practice in a rural community, substantial numbers of graduates will choose to practice in primary care following their residency training. This approach has been demonstrated in a number of medical schools across the country.

The deans wish to attract the best and brightest students to their schools. The problem is how they measure the students’ suitability and the people they choose to rank the candidates. High grade scores and high MCAT scores are insufficient measures of future performance. In addition, a selection process overwhelmingly dominated by basic science and sub-specialty faculty members is also problematic. The first principle of selection is that people have a strong tendency to pick candidates who “look like” themselves. If you want to select a pool of students who will later choose sub-specialist careers, ask a group of sub-specialists to interview and rank the candidates.

It is time for the deans to take responsibility for who they select as students and how they support their students’ career development. The programs that select students who are likely to practice as primary care physicians actually deliver the goods. Every medical school is capable of producing the students needed to serve through careers in primary care and as future physician investigators.

Given the deans efforts to increase their class sizes it would make sense that they designate a portion of the growth to a program that selects and supports students interested in primary care. It’s time to stop pretending they have no options. The deans can satisfy both their inner yearnings to produce sub-specialists and physician investigators and the public’s need for physicians who will care for the people. Acting as though this is an either/or issue when it is a both/and issue, reveals a lack of imagination. Our medical schools can do better.

Laurence Bauer, MSW, MEd is Chief Executive Officer of the Family Medicine Education Consortium (www.fmec.net) a not-for profit organization that supports the growth of academic family medicine in the northeast region of the US. He can be contacted at laurence.bauer@sbcglobal.net