Diana Huang entered medical school ready to work hard to realize her ambition of becoming a primary care doctor. What she wasn’t prepared for was the tepid support she has gotten from some classmates and faculty regarding her chosen specialty.
“I definitely got messages along the way where I could tell people had the attitude of, ‘it’s fine if you want to do that, but it’s not anything impressive,” says Huang, a fourth-year student at Temple University’s Lewis Katz School of Medicine in Philadelphia.
Huang’s feeling that she receives little encouragement for a career in primary care is common among medical students. Changing the attitude that produces it—that specialization is preferable to more general medicine—is but one of the challenges schools face in trying to graduate enough primary care physicians to meet the expected demand—challenges ranging from their admissions policies to the difficulty of finding acceptable sites for primary care rotations.
“The AAMC [Association of American Medical Colleges] endorses the notion that we need a strong primary care workforce,” says Scott Shipman, MD, MPH, director of primary care initiatives and workforce analysis at the AAMC. He adds that the association’s projections “suggest that we are falling short on creating enough primary care practitioners to meet the projected demand, although there is also a shortage of physicians in many specialties.”
At the same time, Shipman notes, students base career decisions on many factors, and in the absence of a national allocation structure for graduating students, “much of the output of the medical workforce is dictated by student preferences and the availability of GME [graduate medical education] positions,” rather than anything schools themselves can do.
While many of these issues lie outside the control of physicians now in practice, those concerned about the future supply of primary care doctors do have opportunities to help, experts say. These can take the forms of mentoring individual students, speaking at medical schools or allowing students into their practices, either to shadow physicians or as part of a clinical rotation program. (See sidebar.)
Primary care shortage expected to increase
Healthcare policy experts and physicians’ groups have been sounding the alarm about a looming doctor shortage for more than a decade, but the problem shows no signs of abating. A 2016 study of physician supply and demand commissioned by the AAMC forecasts a primary care physician shortfall ranging from about 15,000 to more than 35,000 by 2025—even though the number of graduates matching to residencies in internal and family medicine and pediatrics has been trending up in recent years.