Viewpoint: Encouraging Student Interest in Family Medicine: Texas Tech’s Family Medicine Accelerated Track
AAMC Reporter: November 2011
By Steven L. Berk, M.D., Executive Vice President and Provost, Texas Tech University Health Sciences Center; Dean, Texas Tech University Health Sciences School of Medicine
The United States is facing a serious shortage of physicians, which will become most apparent by 2020. Medical student enrollment per 100,000 populations has been declining. Doctor visits for those over 65 are sharply increasing. The physician workforce is also aging, at a time when the career goals of graduating physicians may be focused on working fewer hours.
The AAMC has recognized this potential workforce crisis, and has committed to developing strategies that will increase the number of graduating medical students by 30 percent (compared with 2002 enrollment). I believe this crisis will not be averted unless the increasing imbalance of generalists to specialists is also addressed.
Studies conducted by many organizations such as the AAMC, the Council on Graduate Medical Education (COGME), the Robert Wood Johnson Foundation, and the Pew Commission have established the importance of having at least 50 percent of all physicians providing primary care. Unfortunately, the percentage of physicians in primary care is dropping. The consequences of this deficit also are well established: inefficient and costly care, more heart disease secondary to lack of preventive measures, detection of some cancers at a later stage, and an increase in infectious disease that could have been prevented by vaccination.
When the medical school experience ends, only about 10 percent of students enter family medicine. Most of the students who choose internal medicine or pediatrics are actually destined for specialty careers. Only 25 percent of internal medicine graduates will stay in primary care, down from 54 percent a decade ago. For graduates of family medicine, on the other hand, statistics from the American Academy of Family Physicians indicate that more than 90 percent make careers in primary care and almost 40 percent do so in communities of fewer than 25,000 people or areas of the inner city that could be considered low income.
Of course, there are some encouraging signs. For example, in 2011, for the second year in a row, more U.S. medical school seniors will train as family medicine residents, according to the National Resident Matching Program. All told, the number of U.S. medical school seniors choosing family medicine has increased by about 20 percent in the past two years.
Still, there is work to be done in this area. There are several explanations for the loss of interest in primary care. Student debt is certainly a source of discouragement for some students contemplating a primary care field. In addition, anecdotal data abound to suggest that our medical school culture dissuades students from family medicine and into more technologically oriented disciplines.
The time is right for medical schools to take some responsibility for the demise of primary care and look for innovative approaches to rejuvenate these disciplines. Efforts such as the selection of students (perhaps from small towns and urban areas) who are likely to become primary care physicians, developing continuity clinics for all third-year students, and selective scholarships are being used with varying levels of success. In the late 1980s and early 1990s, an extraordinarily successful pilot program enabled students to do both their fourth year of medical school and first year of primary care residency at the same time. Twelve participating schools all reported the success of the program, but the pilot was not continued by the ACGME and strong efforts to reestablish the program in 2008 were unsuccessful, in part because of administrative concerns.
The Family Medicine Accelerated Track (FMAT) of Texas Tech University Health Sciences Center’s (TTUHSC) School of Medicine was created out of this successful accelerated track experience.
The FMAT consists of a modified three-year curriculum that will lead to the M.D. degree followed by a standard three-year family medicine residency program, ideally to be completed in one of the TTUHSC family medicine residency programs. The track is open to 14 students per year who are selected within the first year of medical school. There will be financial benefits for students who match with a TTUHSC program. However, FMAT students will enter the National Resident Matching Program and may select residency programs outside of the TTUHSC programs.
The program creates a high level of enthusiasm among students and is considered prestigious. Student debt is decreased 50 percent, because of a full scholarship for the first year and no fourth-year tuition, and because students will draw a resident stipend one year earlier. While we cannot change salary inequities across the system, we can make a difference in student debt and how it affects career choice.
The three-year curriculum for FMAT students requires modifications and enhancements to the current curriculum, to ensure that FMAT students obtain all required training using a timeline that permits them to fulfill all of the graduation requirements within three years. As such, graduation is, in essence, based on fulfilling competencies. Recently, the Carnegie Foundation released a study recommending that three-year curricula be an option for medical schools, and that a focus on learning outcomes and competencies must be the currency for advancement.
FMAT has been approved by the Liaison Committee on Medical Education (which has approved three-year curricula for all students in some Canadian medical schools). Leaders from other schools have expressed interest in our program and in establishing similar programs at their institutions. This summer, nine highly motivated students with credentials that put them in the top half of their class are working with basic scientists and role-model family physicians in a course that will prepare them for a longitudinal family medicine clerkship in the second year. The eight-week period that opens up in the third year will be used for some of the fourth-year requirements such as a sub-internship and ICU. Many electives taken by fourth-year students such as orthopedics, ENT, and emergency room will be elective options in the family medicine residency curriculum.
West Texas needs more family physicians, and our school of medicine is committed to meeting the needs of our community by making the training and practice of family medicine more attractive to our students.