A lack of incentive for medical schools to train primary care doctors

A social media movement is happening before our eyes with action starting to take shape.  The #occupyhealthcare movement has begun within to the blogosphere and through various areas of social media by storm.

What does the #occupyhealthcare movement mean to me?  My main focus in advocacy for family medicine is the production of an adequate primary care workforce distributed adequately to best serve our country.  Those close to me also know that the current climate of health care access, quality and cost in the civilian world is one of my main reasons for pursuing a medical career in the military. What does that have anything to do with occupying healthcare?

First, we must occupy healthcare to produce the primary care workforce that our country needs.  There are a number of ways that this needs to be accomplished.  We must quit investing money into procedures and interventions that provide no decrease in morbidity and mortality for patients.  We need to shift our investments towards cognitive evaluation and management of patients in an effort to prevent diseases from occurring in the first place.  If they are already present, we need to invest in the cognitive efforts that are most proven to help our patients prolong or stop the progression of disease.  By doing so, we will attract the best and brightest medical and other professional students towards professions within patient-centered medical homes.  Our patients deserve nothing less than the best to provide ongoing, life-long, multidisciplinary care.

Second, we must occupy healthcare to decrease bureaucracy within medical schools.  This starts with how medical schools are “ranked” and funded.  Consider how much emphasis is put on NIH funding for research towards rank and prestige.  When looking at funding for research, most of the research done at these institutes are within tertiary care centers, where less than 1% of our population actually receives care.  This funding needs to be shifted towards research within our communities, to best represent the needs of the 99% of those who never make it to the ivory tower, academic tertiary care centers; to the 99% who would be better served by research that actually addresses the problems that they face.

There is no incentive for schools to produce the primary care workforce necessary for our country.

Do not get fooled by “The Dean’s Lie,” where medical schools count all students choosing internal medicine, family medicine, and pediatrics without accounting for the 80-90% of them that will eventually specialize and never practice true primary care.  In any other profession, this would be considered fraud.  How can we let them get away with this type of misrepresentation regarding how they contribute to our primary care workforce?

Should we incentivize NIH funding in proportion to primary care workforce production?

Medical schools argue that their main job is to educate and train future physicians and that the choices of students is out of their hands.  Is it?  How many family physicians teach core competencies, including anatomy and pathology, during the first two years of medical school?  Are they stuck teaching clinical skills?  Is primary care valued at these schools – does the school have a family medicine department?  Does the admissions committee have primary care physicians involved in the selection of potential students?  Do other departments value primary care or do they tell medical students that they are “too smart” for primary care?

Without an adequate primary care workforce, not many people are going to have access to the patient-centered care necessary to screen and/or manage the many diseases that our country suffers from, most which could be prevented with high quality primary care.  This starts with our workforce and ends with how we value services provided by our system.  We pay more to keep people sick and less to keep people healthy.  In turn, we attract more medical students to pursue careers in areas that keep people sicker and longer rather than careers in primary care where we can make the biggest impact on people’s lives with the lowest cost to our healthcare system.

The current climate forces those interested in keeping their jobs to make good business decisions in return for one of the worst healthcare systems among developed nations.  What a shame.  Let’s #occupyhealthcare to allow those in charge (or those who will be in charge) to make the good business decisions necessary to create a system that everybody can be a part of.

Kevin Bernstein is co-founder of Future of Family Medicine.

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  • Anonymous

    You lost me at the #occupy meme.

  • Anonymous

    So true.  Primary Care Medicine was undervalued when I was in Med School, about 30 years ago, and unfortunately, it continues.  And I was at a Medical School that touts its Primary Care values.

  • http://profiles.google.com/birthherstory D’Anne Graham

    “We must quit investing money into procedures and interventions that provide no decrease in morbidity and mortality for patients.” I know midwives that could put obstetrics out of business and massage therapists who could do the same to orthopedics, and as a mother of 5, pediatrics is pretty worthless too. 

  • Anonymous

    I am a medical student at University of Washington, and I feel as though there is a tremendous amount of support for those interested in family med (specifically in rural areas). Granted our program is perhaps more geared towards that than most, but I would be surprised if it was too different at other schools.

    If you want to attract more people to family med the best place to start would be reimbursement.  

  • http://www.nedcon.ro/ Jonathan Nichol

    I would like to say this is the best blog that I have ever come across. Very informative. Please write more so  we can get more details.

  • http://www.facebook.com/people/Steven-Reznick/100000549195050 Steven Reznick

    If federal funding to medical schools discriminated against procedure oriented specialty departments and paid a bonus for programs that had students practicing in the primary care specialties a decade post graduation , and if the reimbursement for evaluation and management services and cognitive work were increased, we would produce and retain more primary care physicians. As long as the Medicare Payment Review Commission in concert with the AMA, ACP and specialty societies keeps 19 procedure oriented specialists on the committee that decides reimbursement rates out of 23 members , we will have a  primary care workforce problem !

  • http://dinosaurmusings.wordpress.com/ #1 Dinosaur

    Check out Primary Care Progress (http://primarycareprogress.org/home), an organization devoted to Primary Care advocacy in medical schools and among residents.

  • http://twitter.com/joebrad1326 Joe Bradley

    Focus on cutting the ungodly amount of debt that medical students graduate with and they may be more likely to consider primary care specialties. Too many of my classmates chose to specialize because of debt concerns, even though they were very interested in primary care.

    Yes, specialists and proceduralists get paid more than primary care physicians although the PCP spends more time with the patient. However, when I take a patient to the operating room, I am assuming a far greater risk in the care of that patient and I should be reimbursed appropriately for that heightened risk.

  • A Kazen

    I have to agree that suggesting we “occupy” healthcare kills your credibility. As a med student, my life is hard enough already without living in a tent ;) 

  • http://pulse.yahoo.com/_2LRZNHDZS6DU45WQ567LPQ7CMI ninguem

    Is it just “the Dean’s Lie”?

    Are the students put in a position where they have to claim great interest in primary care in order to be admitted in the first place?

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