In a previous post, I described a study that found that U.S. medical graduates from 1997 to 2006 who became primary care doctors were "more likely to be female, planned to practice in medically underserved communities, and had strong altruistic beliefs about health care and the medical profession's social responsibility." Another research group recently used the percentage of gradutes who practice primary care as one of their "social mission" criteria for ranking medical schools. But using retrospective profiles as the basis for recruiting new students, and promoting schools that have historically graduated higher proportions of primary care physicians, will not be enough to meet the basic health needs of 32 million newly insured patients by 2014, much less those of patients whose family doctors are now nearing retirement.
As if we need another example of how hard it is to prime the primary care pipeline, The Commonwealth Medical College (TCMC), a school in northeastern Pennsylvania that opened its doors in August 2009 with a stated emphasis on training primary care physicians to address the state's widespread workforce shortages, reported in the July/August issue of Family Medicine that the career preferences of its inaugural class changed dramatically between medical school acceptance and matriculation:
In contrast to our students' often-stated primary care proclivity before matriculation, results of the orientation survey just 3–6 months after medical school acceptance and before their first class disclosed that seven (12.5%) students cited general surgery and orthopedic surgery, respectively, as their first career choice, and four (6.2%) students listed emergency medicine. Only 15 (23%) students indicated a preference for general internal medicine (eight students), obstetrics-gynecology (four), family medicine (two), or pediatrics (one). Graduating medical students who are focused on a career in primary care is difficult, and our experience indicates that even accurately identifying medical school candidates with this interest can be fraught with error.
Students change their minds about specialty choice multiple times during medical school, and there is obviously plenty of time left to persuade members of this class of the benefits of a career in primary care. I also hope that TCMC's innovative community-based training curriculum provides students with a more balanced perspective on population health problems than does the average tertiary care-focused academic medical center. A great deal is riding on the outcome of this program, not only for the residents of Pennsylvania, but the entire nation. If it succeeds, perhaps medical schools around the country will follow suit. But if it fails ... what then?