Monday, September 28, 2009

Re-priming the primary care pipeline

If you've been reading this blog since its inception, you are now well aware that primary care is essential to any high-performing health system, including those in other countries, but that the "pipeline" for primary care physicians in the U.S. has been drying up, with large student debt burdens and discrepancies in income between generalist and subspecialist physicians playing a large part in driving medical students away from careers on the front lines of medicine. So how can the supply of primary care physicians be increased to adequate levels in the context of health care reform?

A group of family physicians and health policy analysts at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care recently did an exhaustive study on the factors that affect medical students' selection of careers. In their exceptional March 2009 report, subtitled "What Influences Medical Student & Resident Choices?" Dr. Robert L. Phillips, Jr. and colleagues made several evidence-based recommendations for policymakers that bear repeating (and tweeting) loudly in the White House and halls of Congress:

1. Create more opportunities for students and young physicians to trade debt for service.
2. Reduce or resolve disparities in physician income.
3. Admit a greater proportion of students to medical school who are more likely to choose primary care, rural practice, and care of the underserved.
4. Study the degree to which educational debt prevents middle class and poor students from applying to medical school and potential policies to reduce such barriers.
5. Shift substantially more training of medical students and residents to community, rural, and underserved settings.
6. Support primary care departments and residency programs and their roles in teaching and mentoring trainees.
7. Reauthorize and revitalize funding through Title VII, Section 747 of the Public Health Service Act. (Title VII is a small, little known federal program that supports primary care residency training, but has been severely shrunk by budget cuts during the past decade.)
8. Study how to make rural areas more likely practice options, especially for women physicians. (The report found that "female physicians are twice as likely as men to choose primary care but helf as likely to practice in rural areas.")
9. New medical schools should be public with preference for rural locations. (One recently established medical school, the Commonwealth Medical College in Scranton, PA, exemplifies how this recommendation will encourage students to pursue primary care careers.)


In the interest of full disclosure, I'd like you to be aware that the Robert Graham Center is an editorially independent subsidiary of one of my employers, the American Academy of Family Physicians, and I did some freelance editing assignments for the Center from 2005-06. I no longer have any direct professional connections with their staff, but I encourage them to read my blog!

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