Photo credit: www.cbsnews.com

Challenges and Promises in Primary Care Medicine Training

Julia Lo Cascio’s aspiration of becoming a pediatrician has seen her through medical school at the NYU Grossman Long Island School of Medicine, a new institution aimed specifically at addressing the training needs of primary care doctors. As she approaches graduation, her commitment to pediatrics is unwavering, yet she stands in contrast to a trend where many medical graduates veer towards more lucrative specialties.

Recent statistics highlight a significant trend: in 2024, 252 of the 3,139 pediatric residency slots offered in the United States remained unfilled, alongside 636 unfilled family medicine positions out of 5,231. The numbers illustrate a move by students towards higher-paying fields within medicine, leaving primary care increasingly underserved.

Lo Cascio, 24, credits her three-year accelerated program for reinforcing her dedication to pediatric medicine. However, this situation raises an urgent need for medical schools to take a more proactive approach to fostering interest in primary care fields. The Association of American Medical Colleges has issued a dire warning, projecting a shortage of between 20,200 and 40,400 primary care physicians by 2036, a forecast that underscores the potential impact on the American healthcare system.

Initially, many medical students express a desire to pursue primary care, but their enthusiasm can wane as they immerse themselves in the complexities presented by hospitals affiliated with academic medical centers. These environments often showcase intricate clinical cases and tend to prioritize specialty training.

Financial incentives play a significant role in this trend, with many graduates opting for specialties that offer higher compensation. Andrew Bazemore of the American Board of Family Medicine notes that “subspecialties tend to generate a lot of wealth, not only for individual specialists but also for the entire hospital system.” Additionally, the availability of grants from federal agencies and pharmaceutical companies often dictates the prestige and resources of medical departments.

Notably, some prestigious schools lack comprehensive family medicine departments, with at least 12 institutions, including notable names like Harvard and Johns Hopkins, not offering robust family medicine training. Graduates from these schools frequently gravitate towards lucrative subspecialties.

One possible strategy to counteract these trends involves eliminating tuition fees, thereby allowing students to make career choices based on passion rather than financial necessity. In 2024, initiatives from the Albert Einstein College of Medicine and the Johns Hopkins University School of Medicine showcased this approach, as charitable contributions enabled them to waive tuition fees.

Nevertheless, the contrast between Lo Cascio’s school, which also does not charge tuition, and its sister institution highlights the limitations of this model. At Lo Cascio’s Long Island school, two-thirds of graduates pursued residencies in primary care—revealing that financial factors were less significant than passion for those committed to the field. In comparison, the Manhattan-based NYU Grossman School of Medicine saw the majority of its 2024 graduates select specialties like orthopedics or dermatology, which offer considerably higher average annual incomes.

Primary care often faces an image problem, with many viewing it as less prestigious. This perception persists both among peers and faculty, as illustrated by Anand Chukka, a Harvard Medical School student who faced skepticism regarding his choice to pursue primary care. Subtle cues, such as access to lunches during hospital rotations, can subtly influence students’ preferences and reinforce biases against primary care specialties.

Despite such challenges, Chukka remains committed to primary care, driven by his desire to serve underserved populations. His impactful experiences during clerkships have solidified his career path.

Looking ahead, primary care appears daunting for many due to the administrative burdens associated with the role. Caroline Richardson, chair of family medicine at Brown University’s Warren Alpert Medical School, emphasizes that while specialists encounter bureaucracy, primary care physicians face a more overwhelming load of patient management without proportional support.

Kevin Grumbach, a professor at the University of California-San Francisco, has previously worked to steer more students toward primary care, only to realize that systemic issues, including low compensation and inadequate support, require broader changes than what can be achieved within medical schools alone.

However, some institutions have managed to cultivate higher rates of primary care practice among graduates through targeted programs and mentorships. For instance, U.S. News & World Report’s recent ranking of medical schools by the percentage of alumni practicing primary care for six to eight years post-graduation reveals that osteopathic schools lead the way, with rates as high as 47%. These schools traditionally emphasize primary care, graduating a larger proportion of the primary care workforce.

Conversely, elite schools like Yale, Johns Hopkins, and Harvard report low percentages of graduates pursuing primary care, mirroring the trend seen amongst other prestigious institutions. In contrast, public universities focused on primary care, such as the University of Washington and the University of California-Davis, boast significantly higher primary care graduate rates through strategic initiatives and community-focused programs.

Despite debates surrounding the establishment of schools dedicated to primary care, advocates like Toyese Oyeyemi Jr. express concerns that such efforts may distract from recognizing primary care’s foundational role in healthcare. Nevertheless, Lo Cascio’s experience at a primary care-focused medical school has empowered her to stay true to her pediatric aspirations. Her personal journey underscores the critical role pediatricians play in patients’ lives. “Your pediatrician is the person you can come back to,” she reflects, passionate about being that source of support for others.

KFF Health News is a national newsroom dedicated to producing in-depth journalism about health issues, operating as a core program at KFF, a leading independent source for health policy research and journalism.

Source
www.cbsnews.com