While there is some disagreement on how severe the physician shortage in the U.S. is, the majority of experts and research studies agree that primary care physicians are the most needed. A new call to action provides a blueprint for shoring up this workforce by helping medical students see the benefits of choosing primary care.
“This document describes the important roles that high school and college education, medical education, the physician community and the public and private payment sectors play in producing the physician workforce that the United States needs,” said Reid Blackwelder, MD, president of the American Academy of Family Physicians.
Building up the primary care physician workforce will be a long and complex effort, said Perry Pugno, MD, vice president for medical education at the AAFP. He says the blueprint will serve as the collective education tool for all of the respective organizations involved in the blueprint’s creation to draw attention to the shortage and help put initiatives in place to reverse it.
“We thought it would be useful to create a concise statement that would be sufficiently all-encompassing; that would represent the interests of all of the various constituencies within family medicine; that would allow us to communicate our positions clearly and succinctly; and that would create something that we all could use in our advocacy efforts to our mutual benefit,” Pugno said.
The organizations publishing the blueprint include the Association of Departments of Family Medicine, the Association of Family Medicine Residency Directors, the Society of Teachers of Family Medicine and the North American Primary Care Research Group – with support from the American Academy of Family Physicians and the American Board of Family Medicine.
Four pillars to support a new workforce foundation
To reverse this shortage, the blueprint maps out needed actions in four key areas: pipeline, process of medical education, practice transformation and payment reform.
The pipeline
“The pipeline of family physicians for the nation leaks – it leaks a lot,” Pugno said. To stem the leaks, the blueprint suggests creating a continuum of identification, recruitment and education that begins in the early school years. Other ideas for impacting the pipeline include proactively seeking to increase the number of primary care physicians and other supporters of primary care on medical school admissions committees and to understand and address lifestyle concerns of medical students, such as the increasing debt that pushes them to seek careers in specialties rather than primary care.
Process of medical education
The process of medical education takes a look at curriculum. “There are components to the curriculum that we have needed to augment in recent years, including the organizational leadership competencies, to be able to lead a patient-centered home, so we need to make sure our young people are trained along those lines,” Pugno said. A review of the curriculum also includes a hard look at the “hidden curriculum,” he said, meaning the negativity or trash talk that devalues primary care.
Practice transformation
To embrace the patient-centered medical home model, training must be provided to create organizational skills to manage populations of patients and operate within teams, Pugno said.
Payment reform
The disparities caused by how primary care physicians are compensated and how specialists are compensated has created tension and may be steering medical students away from primary care careers. The blueprint asserts that the medical community needs to better compensate and reimburse primary care providers so that the role becomes more attractive from a financial perspective. “We need to close that payment gap if we want to move young people toward careers in the general disciplines to address the healthcare needs of the nation,” Pugno said.