Just about every U.S. medical student who’s ever said they want to go into family medicine, or even other primary care fields, has heard this (or something like it): “Why do you want to waste your brain?”
A new study shows what we in family medicine have always known/suspected. The comments and attitudes are historic, persistent, and pervasive. In this study, the author analyzed oral primary care histories collected in the mid 1990s by Fitzhugh Mullan, which had been deposited in the National Library of Medicine. Graduation years 1935 to 1985 were covered.
Two-thirds of the interviewees reported discouragement or disparagement about primary care, and the proportion remained high for 5 decades. The culture and structure of medical education were sited as the unifying reasons for the disparagement.
This was not a conclusion of the study, but I would add as causative factors money and money. The persistent payment gap between primary care and ologist care drives medical students away from primary care. It’s not a student loan issue. Medical students are actually sharp and can look beyond a 10-year loan repayment period. Within the medical schools themselves, the total lack of primary care research funding at the federal level means family physician researchers have been set up to fail at supplying king medical school dean with the coin of the realm: NIH research dollars. Nurses, social workers, and complementary medicine advocates all have institutes devoted to funding their research interests. There is no equivalent institute of primary care, complex care, comprhensive care, multi-morbid care, or family medicine.
There is a predicted shortage of 33,000 primary care physicians by 2025. Something drastic need to happen at the medical schools to ameliorate this. With the expected gridlock in Washington predicted to continue, optimism for meaningful change is in short supply.