As a child, Clay Buchanan heard so many stories of his pediatrician-father's patients that he practically considered them kin. So when he decided to switch gears after a 20-year career in law and go to medical school, family medicine felt like a fit—even though his sister, already a family practitioner, suggested that he at least consider a specialty with greater income potential. "You get to have relationships with your patients for years. Plus, I like that you treat the whole person, rather than just their kidneys or their heart," he says.
It's not that money isn't a concern for Buchanan, a first year student at Texas Tech University Health Sciences Center School of Medicine in Lubbock. He's 47, with three children to support, which makes taking a long break from the workforce and investing a bundle in tuition a substantial financial risk. That's why he's happy he was accepted into the new "fast-track" program Texas Tech is launching this fall that compresses four years of schooling into three for a select group of students who commit to practicing primary care.
Texas Tech is not the only institution angling to lure more students into primary care, which typically includes family medicine, internal medicine, and general pediatrics. "Medical schools have really stepped up their efforts," says Roland Goertz, president of the American Academy of Family Physicians (AAFP). This is especially true for many of the 15 new medical schools expected to open their doors across the country in the next few years, following decades of negligible growth.
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Several, including Quinnipiac University School of Medicine in North Haven, Conn. and the University of California–Riverside School of Medicine, say a key part of their mission is to expand the pool of primary care docs. Similarly, nursing schools are working to graduate more master's-level advanced practice registered nurses (APRNs), a group that includes nurse practitioners who provide primary care; in some states, these master's- or doctoral-level professionals practice independently of a doctor, while in others they see patients in some degree of partnership with a physician.
Why the sense of urgency? A deficit of generalists looms; the shortage of primary care doctors is projected to reach 39,000 or more by 2020. The confluence of causes includes baby boomers' certain demand for more medical care as they age; the pressures of adding some 32 million people to the insurance rolls under the new healthcare law; the large numbers of graying primary care physicians getting set to retire; and the trend of prospective doctors drawn instead to more lucrative specialties.
Fewer than 10 percent of U.S. medical school grads currently opt for family medicine, for example. Last year, 1,184 students accepted residencies in this area, a big drop from the 2,000 who did in 1999.
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Established schools, too, are playing up primary care, going so far as to create separate operations dedicated to it. An institute for primary care innovation was recently announced at the University of Connecticut School of Medicine in Farmington, along with partner St. Francis Hospital and Medical Center, where physicians will conduct research on care delivery and how to improve it, offer information and support to current primary care physicians, and, importantly, develop tomorrow's workforce.
"The institute will give students a home where primary care is the center of the universe, in terms of both patient care and top-notch academic research," says Bruce Gould, associate dean for primary care. The school intends to develop a four year track that will offer extra clinical experiences and provide interested students with mentors to guide them throughout their training.
Harvard Medical School has similarly announced the creation of a center, funded by a $30 million gift, dedicated to research and education in health systems and primary care delivery. The center will also provide students with funding for their own research in the field.
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Because nurses will play a crucial role in filling the care gap, universities that offer advanced practice credentials are similarly looking to expand their student bodies. Enrollment in master's degree nurse practitioner programs leaped to more than 38,000 in 2010, from 21,000 in 2004, reports the American Association of Colleges of Nursing. New York University College of Nursing and the University of Alabama—Birmingham School of Nursing have about doubled their NP enrollment in the past few years, for example.
And some 120 schools of nursing, including those at Stony Brook University in New York and Vanderbilt University in Tennessee, now offer doctoral degrees in nursing practice, up from just 20 in 2006; an additional 161 programs are in the planning stages. Unlike the more research-oriented nursing Ph.D., the D.N.P. degree prepares graduates to provide highly skilled primary care and to work in healthcare administration.
Doctors and nurses alike who are willing to go where they're most needed can often get a big hand from the government in paying back their loans. Uncle Sam's National Health Service Corps offers up to $60,000 for two years of service in approved areas such as rural or public health clinics and prisons; people willing to stay on for six or more years can conceivably see their total debt retired.
Many states, too, help repay or forgive part of the debt of primary care practitioners; doctors who practice in underserved areas in Massachusetts and Virginia, for example, can shave up to $50,000 off their loan balance in exchange for a two-year stint.
Plenty of medical students and aspiring nurses still arrive at school "with a calling to heal the world," UConn's Gould observes. And these days, it's much more likely than in the recent past that the early spark—the impulse to serve all sorts of patients and all sorts of needs—will be fanned to life.
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