Where will new primary care docs come from?

There is widespread consensus that the upcoming increase in the numbers of people who will gain health insurance as a result of the Patient Protection and Affordable Care Act will require a corresponding increase in the numbers of primary care physicians trained to care for them, even if new practice models eventually redistribute physicians' workloads and health insurers' policies change to accomodate these new models (by paying for medical advice dispensed over e-mail, for example). I've previously mentioned in this blog that researchers at the American Academy of Family Physicians' Robert Graham Center have been hard at work for the past several years figuring out what besides salary attracts medical students to careers in family medicine, general internal medicine, and pediatrics.

This month, a study in the journal Academic Medicine provides additional perspective on the steps that policymakers and academic leaders need to take to revitalize the pipeline for primary care training. This analysis of more than 100,000 medical school graduates from 1997 through 2006 who completed a questionnaire administered by the Association of American Medical Colleges (this must have included me, though possibly not - only 65% of all graduates during these years actually completed the survey) studied statistical associations between choice of a primary care specialty and a slew of other factors.

The study's major findings aren't terribly surprising: in terms of percentage of medical school graduates entering their fields, primary care has been losing ground to internal medicine and pediatrics subspecialties for more than a decade. Students who chose primary care were more likely to be female, planned to practice in medically underserved communities, and had strong altruistic beliefs about health care and the medical profession's social responsibility.

If we believe the findings from this study - and there's no reason not to, given that they are largely consistent with those from previous studies - it makes sense for medical schools to respond by targeting recruitment efforts for women and college graduates who already plan to practice in underserved areas and who see health care as a basic human right, rather than a privilege provided for those who can afford it. It also makes sense for schools to take a more active role in promoting the whole-person (or "holistic," if you prefer) philosophy that underlies the primary care specialities from day one, rather than misleading students that the segmented, organ-system organization of the typical academic medical center is a sensible approach to improving population health.

But will medical schools actually do any of these things, and more importantly, will it really matter if the primary care-speciality income gap persists?