Students who are the evangelists of family medicine for tomorrow

Recently, I was in a meeting organized by the American Academy of Family Physicians in an effort to understand the lack of student interest in family medicine as well as to encourage brainstorming among those of us charged with facilitating interest on ideas that might work and be transportable.

I was with Bill Coleman from Alabama (among others) and was pleased to discover that we were ahead of the region. We have mostly tried what has been shown to work (pipeline programs, selective admission, educational activities in medical schools among other things) and thanks to Bill have a budding Student AAFP chapter that is attracting attention.

What I found most impressive was the collection of students that the Academy had assembled. These 8 or so students were committed, enthusiastic, and engaged. They are the evangelists for family medicine for tomorrow. When asked how to improve interest, they did not offer Twitter or Facebook as the answer. They offered three concrete barriers that we will have to overcome if we want to increase the number of highly qualified applicants into our family medicine:

  1. Students want assurances that their income will be sufficient to cover the cost of their student loans. At current rates, they are scheduled to pay $36,000 annually for 10 years to retire an average debt. More and more, students going into primary care are able to obtain debt retirement through service commitments but we as educators need to do a better job of communicating the financial implications of a career in primary care and how to leverage desire into less debt.
  2. Students want mentors. Smart people who can enter any field they want select fields based on advice from mentors and peers. When their peers are all saying “take the money” they need strong mentors to reassure them that it is good to do the right thing for the right reason. Unfortunately, those of us teaching students often do not realize the impact of our verbalized frustrations. To quote from a previous generation, “Loose lips sink ships” and make anesthesiologists.
  3. Students need for us to sell family medicine to the public. They are committed to what they believe is a great specialty. When they brag to their family, they know they won’t hear excitement about impending brain surgery. They do expect to hear pride or at least acknowledgement that a family doctor is a bona fide specialist, and not someone at risk of being replaced by another professional without an MD. We need to do a better job of selling the specialty both in the social media and more importantly in the mass media.

In short, I think the future of the specialty is in good hands. It is our stewardship that makes me worry.

Allen Perkins is Professor and Chair, Department of Family Medicine, University of South Alabama.  He blogs at Training Family Doctors.

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  • Vicki

    I don’t know at what point this needs to be done, but sometime, somehow, someone needs to sell the insurance industry on family medicine as the bona fide specialty that it is, so that family practitioners are not paid less than other specialists. When I used to see an optometrist, my co-pay was equal to what I paid to see an ophthalmologist, a retinal specialist, a surgeon, or an M.D. in any specialty recognized as such by the insurance industry. What an insult! Family practitioners need to educate every group already mentioned in the post, above, AND the insurance industry; otherwise, you will all continue to be looked upon and paid as if you were g.p.’s.

  • ninguem

    “…… effort to understand the lack of student interest in family medicine…….”

    What’s to understand that isn’t already painfully obvious?

  • Leo Holm MD

    Those are some good points.
    The problem is that these students are unlikely to remain enthusiastic, committed or engaged once they go through residency and into practice in the current environment.
    Concerning your three points:
    1. Debt is a big issue, but the income disparity overshadows it. There are plenty of ways to deal with the massive debt incurred from medical education: deal directly with the causes. Streamline the premedical path from college. Reduce the duration of training by making medical school more efficient and cost effective. Allow students to become part of the working solution instead of having the whole educational experience translated into debt. Remember “scut work”? Try some “scut pay” for it. Stop banks from plundering students. We have got to deal with debt at the front end, because you see how difficult it is to raise wages.
    2. Regardless of the attitude of the mentor, students and residents can see the writing on the wall. No amount of grinning and motivational speaking will change this. The practice environment has to change. Seeing someone banging their head against the wall requires no verbalization. Students and residents are cynical long before I get to them. There are reasons for this which should also be dealt with directly.
    3. I believe the public is sold on their Family Physician. People will tell you up front how much they value Primary Care. There is substantial discordance between the way the public feels and how that is translated into reimbursement and perception of Primary Care in the academic environment.

    I’m not sure whose hands the specialty is in. I do not feel like they are mine.
    Your role in educating the next generation is appreciated. These are difficult times to pass the torch.

    • Fam Med Doc

      “People will tell you up front how much they value Primary Care”

      Ah yes, these are the very same people who “value primary care” yet 1) argue about paying their deductible 2) pay good sums of $ for a nice cell phone or car yet won’t pay the balance on their bill to their primary care doctor after multiple letters 3) get angry when informed they must come in to see the primary care doctor for any more more refills cuz they haven’t been seen in the office in more than a year 4) get angry when they are told they will need to pay for that letter written by the doctor cuz their insurance doesnt cover letters 5) get upset when they hear they must come in for a doctors appointment to review the abnormal results & can’t talk on the phone with it with the doctor.

      Oh, the list goes on.

      No, many people who say they “value primary care” say so with their lips but their actions say quite the opposite.

      I’m making barely 140 K as a family medicine doctor. My friend from medical school makes 350-400 K/year. “The public” as a whole is NOT SOLD primary care. It is ” sold” on specialty care. Don’t kid yourself.

      • Kristin

        I’m pretty sure people will be jerks to all their doctors. I base this on an extensive psychological education, which can be summed up neatly: people are jerks.

        Some people are jerks all of the time. All people are jerks some of the time. Doctors’ offices bring out the worst in people, and some people don’t need much incentive to bring out their own worst. Anyone who works in a field where people have to give you money has a selection of horror stories. When I was a student librarian, I once got a death threat over a $15 accrued fine.

        Do people act like jerks more to their PCPs than to specialists? I don’t know. (Actually, that sounds like an interesting line of research. It’s a shame I’m not in research psych anymore.) But it’s not logical to conclude that people value specialists just because they don’t value their PCPs.

  • Fam Med Doc

    “Students want assurances that their income will be sufficient to cover the cost of their student loans.”

    Even if it does sufficiently cover the cost of their student loans what about saving for the down payment on a home? Saving for their retirement? Putting their kids thru college? No, their concern is more than justified, but it should be expand to be concerned will their Family Medicine pay enough to live on in general, even after working 50-60 hrs/week?

    I was once an “evangelist” for Family Medicine. Really. Now I’m an Atheist. I regret going into Family Medicine.

  • bett martinez

    interesting new development, now in beta, Silicon Valley, has received VC funding – SF Business Times quotes founders, says the concept may eventually REPLACE insurance cos.
    check out

    In addition, other mechanisms underway, groups of doctors negotiating directly with hospitals and re-insurers, are now a growing and developing model, again going around insurance administrative costs. One organization out of Indianapolis, which assists the doctors groups in negotiating third party contracts and liability, is considering purchase of a Wellness Company, providing all those things you consider Admin. which are definitely worthwhile…

    Though I make my living as a broker and consultant, if the old model no longer works, let it change, or move on and make way
    for one that works better, and provides more efficient and meaningful services.


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