Primary care residency numbers didn’t change much this year. Depending upon your vantage point, that’s either a good or bad thing. For those who were hoping that the numbers would continue that 2-year steady climb out of the dumps, the 1% increase in FM positions seemed to be a disappointment. But for many of us who work day to day to revitalize the primary care pipeline, we breathed a sigh of relief that the numbers managed to hold steady.
Now don’t get me wrong. There are many pessimists out there who don’t have faith in our primary care health system. I’m not one of them. I have firsthand experience to know that change is afoot all around us in the primary care landscape. I spend most of my time meeting people who are on the cutting edge of the revitalization of the primary care pipeline; people like Dr. Mike Magill of the University of Utah, where they have developed the Care by DesignTM model of primary care. Not only are these primary care heroes reinventing how primary care is delivered, but they’re excited to share this vision for a new, more patient-centered and innovative primary care future with our trainees- to offer them a glimpse of a multitude of new models of primary care delivery that are better serving both patients and providers alike. And many of these leaders, like Mike, aren’t just getting trainees exposed to these new models; they’re getting them involved as well. By doing so, they’re not just helping them see a future for themselves in primary care within these revitalized models, but they’re starting to get these trainees marinating in a new approach to care delivery, getting them familiar with those skills and competencies of team-based care that are almost completely absent from traditional models of medical education and training. And it’s making a profound difference.
The problem in primary care is not a lack of innovation in the field. It’s that forward-thinking programs and efforts are the exception, and not the rule, in academic settings. As Donald Berwick says, every system is perfectly designed to produce the results that it gets. And the honest truth is that our medical education system is just not designed to get trainees excited about careers in primary care.
The vast majority of medical trainees have no exposure to these exciting new models of primary care delivery like the patient-centered medical home. Instead, the overwhelming majority of their rotations, clinical experiences and electives occur within traditional academic practices, which are notorious for utilizing antiquated models of care that serve neither patient nor provider, and turn off medical students in droves.
I recently spoke with an internal medicine resident at a training program in the Midwest. She had entered the program planning on pursuing a primary care career. “There’s no friggin’ way,” she replied when I asked her if she was still planning on pursuing a career in primary care. Clearly, the discrepancies in salaries between primary care providers and specialists was playing a role in her thinking. But when I pressed her, she admitted that it was mostly the models of care she had been exposed to, and forced to practice in, that had dissuaded her from taking the leap. To her, the Patient Centered Medical Home, and other promising, alternate models of care delivery were a fantasy, almost like Willy Wonka land. It was something she had vaguely heard about, maybe even read about, but certainly had no firsthand knowledge of. Instead, she made her career plans based upon her own experience, and that experience had her working in a clinic, “that almost seemed like it had been designed to destroy my interest in a primary care career,” she told me. That’s too bad– for her, for the people of her state who need access to primary care, and for our healthcare system as a whole. What’s worse is that it could have been prevented.
The day prior to meeting this resident I had met with a clinician innovator in her community who had transformed his primary care practice into a patient-centered medical home and was having fantastic results in terms of care quality, overall spending, and both patient and provider satisfaction. What would have happened if our resident colleague had met him and rotated through his practice, if only for a few days?
What would happen if more and more trainees were exposed to the best and most exciting of what’s happening in primary care, as opposed to the most antiquated and overwhelmed? What would happen if more of them didn’t just shadow in these new innovative practices, but actually rolled up their sleeves and became key members of the team transforming a practice?
I bet our primary care match numbers would change. Big time.
I challenge us to find out. Let’s make a commitment over the next year to take a look at every academic medical community in the country and identify the most exciting leaders and innovators in primary care. Let’s recruit them if we have to. But let’s make a better effort at getting trainees exposed to primary care clinical innovation and the inspiring folks on the front lines of these efforts.
Maybe then, we’ll no longer have to hold our collective breath every match day, hoping (praying!) that our low primary care match numbers “hold steady.”
Andrew Morris-Singer is an internal medicine physician and President and Co-Founder of Primary Care Progress.
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