Call goes out for 3-year medical schools—and other ideas for building back the PCP workforce

There’s no easy fix for U.S. healthcare’s severe shortage of primary care providers. However, a few bold strategies could bolster initiatives to rebuild the ranks of PCPs at local, state and regional levels.

So say researchers who reviewed the relevant literature on the subject and had their study published in the Journal of General Internal Medicine. 

“Despite structural and logistical barriers to large-scale shifts in ambulatory general internal medicine (GIM) education,” Tovah Tripp, MD, and colleagues write, “meaningful and actionable opportunities exist for educators, medical schools and Departments of Medicine to strengthen and advocate for a primary care pipeline.”

All such efforts must begin with undergraduate medical education, the researchers maintain. 

Tripp and co-authors break their recommendations into three interlocking domains that, together, shape student experiences and career decision-making by med students mulling work as GIM providers. 

The domains are the primary care/U.S. healthcare ecosystem, faculty development and engagement, and student educational experiences. Here are sample observations and suggestions the authors offer in their discussions of each. 
 

1. Payment gaps and debt burden may contribute to shifts away from primary care.

While debt has a mixed role in students’ career choices, match data continues to show a strong correlation between specialty salary and competitiveness for U.S. allopathic students, Tripp et al. point out. 

“One way to address these concerns is accelerated primary care pathway models, which condense medical school into three years, integrate primary care continuity experiences, and have pathways to placement in affiliate residency programs while reducing debt burden,” the researchers write before noting that more data is needed to suss out the effects of such models on PCP recruitment and retention.

2. While direct compensation for precepting and mentoring is not always possible due to budget constraints, indirect compensation and recognition may incentivize faculty. 

When salary is tied to time at rank, teaching needs to “count” as much as scholarship and clinical practice, Tripp and co-authors maintain. “At a minimum, universities could reinforce the importance of teaching by weighting it appropriately in the promotion process.”

Indirect compensation can be institutionally based in the form of CME/MOC credits—or more broadly at the local or state level. “For community physicians outside the academic structure, incentives such as a stipend or tax credit for precepting learners are an effective tool,” the researchers note. They cite outcomes in Hawai’i showing this approach has resulted in increases in participation in medical education. 

3. The decision to pursue a career in ambulatory GIM is impacted by the interplay between the clinical ecosystem, faculty support and—not least—the student experience. 

While barriers within these domains may feel significant, medical schools and departments of medicine can make a deliberate and sustained investment in innovative and creative experiences, Tripp and team underscore. 

“Although policy change and payment reform may feel insurmountable, more actionable starting points include developing longitudinal educational experiences and mentorship, protected time and schedule flexibility for faculty, and building value-added roles for students,” they write. “Medical schools and general internists are uniquely situated to promote a positive student experience, emphasizing the profound rewards of primary care while working to mitigate the systemic frustrations that discourage student interest.”

Tripp et al. conclude their paper with a call to action directed at medical educators—especially those who might help move the needle on the size and strength of the primary care workforce. 

“As the primary care shortage intensifies, student experiences in ambulatory general internal medicine are an opportunity to inspire the next generation of primary care physicians,” they reiterate. “Medical schools and Departments of Medicine can lay the foundation by elevating ambulatory GIM education through faculty support, development of longitudinal experiences and mentorship, and meaningful student roles.” 

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‘Local efforts are an essential first step but must be paired with advocacy for systemic reform, most notably, revisions to LCME standards to mandate longitudinal ambulatory experiences. Together, these efforts are essential to restore and sustain a robust primary care workforce.’

The paper is posted in full for free.