For our healthcare model to succeed there has to be a recognition by medical school faculty and curriculum leaders that primary care practice must be a major part of the educational process. The goal would be to teach students that primary care is pivotal in making healthcare reforms successful. There need to be efforts to insure that primary care is elevated in stature, and to encourage more top students to join the effort. Specialty training will always be attractive, both intellectually and for higher income.
Financial Challenges for the Medical School Student
There have been many improvements in medical school curricula in recent years, making the experience more clinically oriented and emphasizing problem solving in addition to the classical studies of biology and anatomy. At the same time the costs to the students have risen remarkably. Many students borrowed heavily for undergraduate education, and the high cost of medical education leaves many with hundreds of thousand dollars in debt.
The Impact of High Student Loan Balances
This leads many students, out of necessity, to seek further training in high-income specialties such as cardiology, gastroenterology, nephrology, and a number of surgical specialties. Significantly smaller incomes in primary care careers leaves incentives for primary care lacking.
Family Medicine, general Internal Medicine, Pediatrics, and Geriatrics physicians are often most caring, and highly motivated in caring for a community, in rural areas as well as urban areas.
Geriatric practice presently attracts relatively few individuals in part because some physicians are anxious to care for young persons through their life to enhance their good health. Geriatricians, who are among the most caring physicians, are attracted to the goals of aiding older individuals to live their last years with dignity. On the other hand, it is very difficult to financially succeed in a geriatrics-only practice because of the longer time it takes to sees the older patient, and the complexity of their chronic illnesses. Reimbursement for Medicare is often less than other insurances.
These are challenges to medical school administrators, faculty, and curriculum specialists. It may take some time to reform medical school studies to ensure that more physicians enter primary care practice. Also, the significant financial challenges of students must be addressed by making medical school more “lean and mean” and still provide the excellent training presently being offered.