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More interest in primary care, but are med schools ready?

December 20, 2012

Interesting story from the American Medical Association’s news wire today about the growing number of medical students who are opting to pursue careers in family medicine. Students matched with family medicine residencies are up 14%this year from 2008, the writer reports (based on information from the national residency matching program).

But the story also points out that some of the nation’s most revered medical schools might not be ready to train new family medicine practitioners. Johns Hopkins, Columbia, Yale, and Harvard have no family medicine departments, although some do offer concentrations in primary care and general medicine.

And why does any of this matter? Well, the Affordable Care Act and our nation’s changing health care needs are demanding more of an emphasis on preventative care (as opposed to treating a problem once it gets bad, and often more expensively), not only as a way to bring down costs but also because it’s just better for patients. But we’ve got what many experts call a shortage of primary care doctors now, and we’re not turning new primary care doctors out fast enough to fill the projected gap (some say that gap will be tens of thousands in just a couple of decades). So it looks like medical schools have a big role to play if we’re going to build the health care workforce we need for the future.

One Comment leave one →
  1. January 21, 2013 12:59 am

    There is a lack of awareness of real solutions for primary care for our nation. New perspectives are required.

    Resolving primary care workforce will require emphasis upon sources of primary care that result in the most primary care delivery over a career. The primary care must also preferentially distribute to 30,000 zip codes with 65% of the US left behind with lower to lowest primary care workforce.

    Until our leaders grasp these important principles of health access, we will have more promotions of sources as primary care that fail to result in primary care delivery. We have only 30% primary care result from six sources of primary care graduates. Five sources have increased in annual graduates for decades with little increase in primary care delivery. The one source with by far the most primary care delivery over a career and the most primary care delivery where needed has remained at zero growth in family medicine graduates for 32 class years.

    To even be able to understand what is needed, we must learn to understand the basic needs of most Americans left behind. We must learn to understand how to measure entire careers of primary care contributions (not just training type or first careers or first practice location).

    With some level of awareness it is possible to understand how just one more proposed year of training for family medicine will result in 5 – 10% loss in primary care delivery per graduate and a 20 – 25% decrease in rural primary care delivery per graduate over a career. Not even family medicine leaders grasp these outcomes, just as nursing leaders fail to understand that the 2 years more for a nursing doctorate for NP will result in a 10 – 12% loss of NP workforce per graduate, a 20% or greater loss in primary care and primary care where needed, and a 30% increase in training cost.

    But as long as perspectives of leaders arise from 1000 zip codes with top concentrations of academics, institutions, facilities, corporations, foundations, income, property value, and people – there will not be any real solutions for health access. The solutions are quite simple – permanent broadest generalists with 9 years of post high school education and training. NP and PA could also be solutions, but once again only with 90% permanent employed family practice result for a career – not 25% and falling yearly.

    Specific focus must be most primary care delivery per graduate and most primary care delivery where needed – not some other agenda.

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