Regarding health care systems driving student interest in family medicine
Although student interest in Family Medicine is driven by the health care system, there are some important exceptions.
For years we have known that medical school applications go up and down based on the perceived potential for professional schools such as law schools, engineering, etc. Certainly students have many interests and when it looks better for one path vs another, they choose the other. Many of us feel that the better, more devoted medical students are admitted in the years where it looks better financially in other professions, leaving the students with a more primary desire for medical school and taking away those with other distractions.
Family medicine is really no different. During the managed care years in the US, salaries and job security looked better in FP. In Canada, the FP choice is the quickest route to practice (convenience career) or to emergency rooms (1 yr shorter than ER residency). It is important to understand that these various choices attract a diversity of students. It is important to understand their various interests when trying to do studies on FP interested students and residents and career choices.
There is a group that has remained relatively constant within family medicine since its rebirth some 30 years ago. At this time there were about 600 - 700 FP residency graduates choosing rural practice locations. Throughout the years, despite managed care, despite rural programming, despite increases in females and minorities, despite major increases in the number of residents, the number has remained constant even though the percentages have declined
It is my belief, based on these various pieces of data, as well as the literature by Rabinowitz and studies by myself (AAMC GQ data) and other admissions data, that this group of students is committed to rural practice and that this group will continue to choose family medicine as long as family medicine is the best preparation and best route to go into rural practice.
We have little influence over market conditions and have so far not impacted health systems change, but we have shown the ability to impact admissions in a few limited areas.
Why are we spending millions studying the future of family medicine when we know it lies in the encouragement and selection of students in middle schools and high schools today. The right students include those from rural backgrounds, those from lower socioeconomic origins, those interested in service and with a history of service, those from minority backgrounds, those with greater maturity.
We are a specialty of action and it is a time of action.
Our top priority should be to help rural and underserved high school students by developing curricula that include the following material:
The sad fact is that an M-4 student spending 2 months of electives with little supervision other than us telling him some of the problems, has put together such a program. If you would like examples, email me.
If we choose this action, we will align ourselves with many devoted people and programs and funding sources - these include local resources, Title VII interests, Community Health Centers, etc.
Perhaps by focusing on this one area we will put our front line troops into battle together instead of us wringing our hands and complaining and many of the things we do now.
If we choose this route, in future years we will reap the rewards. We will see continual increases in true interest in family medicine. We will see the impact these devoted medical students will have on underserved communities as they go to serve and to recruit like-minded students like themselves. We will also see a true and continual rise the fp match, as long as FP remains relevant to such devoted students. Actually these kind of students will shape their own medical school and residency curricula, just as they will reshape practices and communities. This is because they know where they came from. Because of where they have been they can be more effective.
If we do this in family medicine, we will reform family medicine into a serving, caring profession, perhaps the only such discipline left in medicine.
Our next priority should be to work with colleges that will feed us more of these students. These include rural and minority schools, agriculture schools, etc. I have found no more devoted group that health professions advisors to work with. They will be valuable allies if we can help them get even a few of these students admitted.
If you do not believe that Family Medicine is well-positioned to help answer many of the nations health care questions, please move on or wall yourself off into yet another specialized area.
If you do believe that we can help solve these problems, then serve well, care well, and interact well with your community and leaders.
Our patients and communities and our nation need us now more than ever. I am becoming convinced that there are few out there in health care that remain faithful to the true calling of medicine.
Medical Schools and RestorationRobert C. Bowman, M.D. rbowman@unmc.edu
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Facilitating More and Better Rural Docs
