I’m a family medicine physician. My career journey has taught me that the difference in specialties is not a difference in intellect or talent. A difference in the skills required? Absolutely. Family medicine calls for a special set of skills and talents – clinical, professional, and interpersonal – that not every medical school graduate possesses. It’s an art and a science, like any field of medicine.
The Affordable Care Act (ACA) has shined a light on the looming shortage of primary care physicians in the United States. The American Medical Association estimates that by 2025, the US will be short by about 130,000 physicians. A large chunk of this shortage will be in primary care, with the Association of American Medical Colleges (AAMC) predicting a shortage of more than 45,000 primary care physicians by 2020. Large round numbers, slightly different dates, same story: a shortage of internists, pediatricians, and family physicians, the doctors that many of us depend on the most.
The ACA may have thrust the primary care shortage into the limelight, but the question of how to address the problem is one that medical schools have grappled with for years. The issue seems to come in and out of fashion, with perennial calls for medical education reform to encourage more medical students to opt for careers in primary care. A few ideas have support across the healthcare spectrum, from physicians, educators, and healthcare system leaders: let’s push more medical training out of large academic hospitals and into more community health centers. Let’s re-examine our admissions criteria and take a close look at applicants who volunteer hours and hours at their local clinic. And let’s wipe away the student loan debt of new MDs who go into underserved areas.
Some of these ideas are shifts in thinking, others merely shifts in dollars. The Council on Graduate Medical Education, a US government body that advises on physician workforce issues, has recommended that the salaries for primary care physicians be increased to a minimum threshold of 70% of the salary for non-primary care specialties. Why? Because they’ve seen this work in both Canada and the United Kingdom, where rises in the median income of primary care physicians have been accompanied by rising percentages of medical students selecting primary care careers.
Better salaries, loan forgiveness programs, community-based training, and a new view for the medical school admissions committee – all of this should help chip away at the 45,000-doctor deficit. But the greatest impact will come from what we don’t do: Let’s stop telling medical students that they are too talented or too intelligent for primary care. Let’s stop cherry-picking the top performers in medical school to become the super-super-specialists in our academic medical centers. Let’s stop undervaluing family medicine, internal medicine, and – really? – pediatrics as medical fields.
A career in primary care can be incredibly rewarding and inspiring. Being an active participant in the health and well-being of an entire family over the course of many years is a wonderful combination of humbling and challenging. Who has the right mix to appreciate that and achieve the maximum impact such a job offers? The job of our medical schools should be to find out.
