Family medicine has always been the backbone of healthcare. The very first physicians were generalists, able to work across fields while keeping compassion as their main focus. But things have changed in the last few decades. At many medical schools, this primary care specialty is considered outdated or unchallenging — even though family doctors are what the country needs most right now.
In November 2013, the U.S. Department of Health and Human Services published a report projecting a shortage of 20,400 primary care physicians by 2020. What could potentially offset this shortage, the report states, is a more fully integrated system of primary care nurse practitioners and physician assistants. But this move is taking its time to develop.
Adding to that, the Affordable Care Act created a soaring demand for primary care providers. It’s of course wonderful that more Americans now have health insurance, but this demand has put stress on the healthcare system. Despite the gaps in public health and the many job opportunities for medical school graduates, primary care — and family medicine in particular — has been regularly shunned.
That appears to be changing, however. For the first time in years, primary care is beginning to draw more young talent. Who is choosing to make the switch? And why are they doing so?
Students Have Been Avoiding Family Medicine
Many students apply to medical school with family medicine in mind. Dr. Andrew Morris-Singer, the president and co-founder of Primary Care Progress, told the New York Times (NYT) that close to half of medical students show an interest in primary care on their first day of classes. By the third year, that falls to 20 percent. The actual number of students who enter primary care specialties is even smaller, at less than 15 percent.
“There’s a culture of discouragement that exists in most medical schools around primary care,” said Dr. Morris-Singer. “A lot of medical schools disparage primary care. They say primary care isn’t a good use of medical school resources, and this is communicated to students in a direct way.”
Beyond faculty discouragement, finances are also factor. The NYT reported that the average primary care physician makes around $150,000 annually — two or three times less than some other specialists.
Some Schools Are Changing the Game
These obstacles are starting to wear away under the concerted efforts of medical schools around the country. Texas Tech, for example, is reducing costs in order to encourage students to pursue family medicine. By enrolling in an accelerated three-year program, primary care physicians are able to graduate one year earlier than normal. Louisiana State University is also among the institutions implementing programs to attract more med students to family medicine and general practice.
Others, like Harvard Medical School, don’t even have family medicine programs — but they want to change that. As STAT reports, the director of Harvard’s Center for Primary Care, Dr. Russell Phillips, says he is “eager to see family medicine flourish at HMS.” This is because the specialty “accounts for about 40 percent of primary care visits in the country.”
Why Providers Love Family Medicine
When students are exposed to primary care earlier, more of them decide it’s the field for them. Some are drawn by a sense of activism and an opportunity to contribute to the common good. Others find it deeply rewarding to cultivate lasting relationships with their patients, and for many students, it’s these personal connections that make the difference.
“Their eyes would just light up,” Clese Erickson, the director of the American Association of Medical Colleges’ Center for Workforce Statistics, told The Atlantic when describing her interviews with medical students pursuing general practice.
Those attending schools with positive attitudes about primary care “are connected with primary care physicians, and practices, and can see something that they would want to wake up every day and do,” Erickson said.
Family medicine’s intellectual component shouldn’t be understated, either. Though some specialists consider the field less rigorous, these physicians often know a lot about a little. Family medicine practitioners, on the other hand, know a lot about a lot. Their knowledge is both broad and intensive — a benefit unique to general practice.
Even as a larger student population begins to embrace family medicine, it will take time before the full demand for physicians, physician assistants, and nurse practitioners is met. Fortunately, family medicine locum physicians offer an immediate and highly competent temporary staffing solution until long-term positions can be filled.
And make no mistake — they will be filled. Family medicine may have been underappreciated for a long time, but the field is finally beginning to see the respect it deserves.