Medical Education

Curriculum and Financing Strategies Need to Encourage Primary Care Training Gao ID: HEHS-95-9 October 21, 1994

The proportion of active doctors who are primary care physicians--family and general practice physicians, general internists, and pediatricians--has dropped from 53 to 35 since 1960. The Department of Health and Human Services predicts a shortage of 35,000 primary care physicians by the year 2000. GAO analyzed student characteristics associated with choosing primary care and surveyed medical schools and residency programs. GAO concludes that reversing this trend would require changes in medical school curricula to expose students to more primary care medicine, as well as changes in the residency financing, which now discourages teaching hospitals from sponsoring primary care training.

GAO found that: (1) choice of career paths in medicine is associated with the characteristics of students admitted to medical schools and with the curriculum and training opportunities they receive during their medical education; (2) the strongest predictor of whether students choose primary care careers is their stated preference for primary care before they enter medical school; (3) students who attend medical schools with family practice departments are more likely to pursue primary care medicine than those students attending schools without family practice departments; (4) once students graduate from medical school and enter residency programs, there is a significant association between program opportunities to expose residents to primary care faculty and the proportion of residents choosing generalist practice; (5) many medical schools do not require students to have primary care experiences before choosing residency programs; (6) financing mechanisms for residency training give greater incentives to training in nonprimary care-oriented settings than in primary care-oriented settings, which places primary care residency programs at a disadvantage because of their use of nonhospital settings for training; and (7) the Medicare payment methodology may need to be modified to provide incentives for training in nonhospital settings.

Recommendations

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