In an American health care system that some would argue needs them more than ever, primary care physicians are becoming a relatively rare commodity.
Medical schools generally aren’t graduating enough would-be practitioners of family medicine, general internal medicine, and pediatrics to keep up with the rate at which today’s primary care physicians are retiring or leaving the practice.
The UConn School of Medicine is working on several fronts to encourage medical students to consider pursuing a career in primary care.
“As we re-engineer the present dysfunctional health care system, the role of the primary care physician will be central to assuring a high quality, affordable-cost system that will meet the needs of the American public,” says Dr. Bruce Gould, associate dean for primary care and professor at the UConn School of Medicine.
But compared with many subspecialties offering better reimbursement rates, less demanding schedules, fewer administrative hassles, and in some cases more prestige, the appeal of primary care medicine as a career is waning. And medical students are well aware of it.
“Part of the problem is that our reimbursement system in this country does not value primary care as it does specialties,” says Angela Stein, a fourth-year student at the UConn School of Medicine who is considering the primary care career path.
“This is a concern, because medical students graduate with a substantial debt burden, and the ability to pay back these loans is an important consideration in career choice.”
One way UConn is trying to encourage more students to consider careers in primary care medicine is through the Urban Service Track, a special mentorship program designed to produce doctors, dentists, nurses, and pharmacists committed to serving Connecticut’s urban underserved populations.
“Generally that translates into primary care,” Gould says.
“The way we’re going to get more affordable and quality care is not through the Lone Ranger approach [the doctor working alone], it’s through integrated teams of health care professionals. We’re training medical, nursing, pharmacy, and dental students to have a broader view of the practice of health care.”
Of the 74 members of the UConn School of Medicine Class of 2009, 33 have been matched with a primary care residency program. Within the primary care specialties are paths to subspecialties, so it’s unlikely all 33 will end up as primary care practitioners.
Michael Csaszar, a fourth-year student planning to practice family medicine, says, “A lot of primary care is about prevention of disease, and it’s about developing relationships with patients. These things take patience and time. It’s easy to see why students may spend six weeks on an outpatient family medicine rotation and not catch on to it.”
The attrition in primary care can have severe implications, particularly in the area of preventive medicine.
Marta Mieczkowska, right, a fourth-year student at the UConn School of Medicine, celebrates her residency program assignment with a friend at the school’s traditional Match Day ceremony March 19. Mieczkowska was matched with her first choice, a pediatrics residency at Yale-New Haven Hospital. Nearly half of the school’s Class of 2009 have been matched with a primary care residency program. Photo by Janine Gelineau
“Without primary care physicians, we will be relying on specialists with focused interest to become responsible for preventative care that may fall outside their scope,” says Dr. Adam Silverman, chief of the Division of Internal Medicine at the Health Center.
“If we lose our primary care docs, patients will get patchwork care, and there will be no overall coordination of care. This is especially important for patients with multiple complex medical problems.”
Second-year student Jennifer Bordonaro says, “Prevention is the key to health and primary care is the specialty that truly focuses on this.”
Bordonaro serves on a committee looking into ways to increase the number of primary care graduates from the UConn School of Medicine.
Still, she says, “I do have concerns over how long it will take me to pay back my loans, and I am concerned that I may have to work to supplement my salary at the expense of spending time with my family.”
Silverman believes many of the answers lie in reforming the health care system.
“We need to reimburse docs for thinking as well as doing,” Silverman says. “We need a unified medical record and a unified or single payer, so that there is one set of rules for everyone. We also need tort reform to reduce the amount of waste expended in defensive medicine.”
Until that happens, Gould urges tomorrow’s physicians to consider a primary care career for other reasons.
“If you want to have an impact on individual patients, their families, and their communities,” he says, “and, on the national level, affect the health care status of the entire population, then primary care – using the medical home model, with its focus on improving and optimizing health status and outcomes – is the way to go.”
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