Demand for physicians as teachers expected to rise

Pulmonologist Ronald Silvestri, MD, recruits up to 180 physicians annually to teach medical students. As a Harvard Medical School course director at Beth Israel Deaconess Medical Center in Boston, he asks his fellow physicians to contribute anywhere from an hour or two as a lecturer to 40 hours or more as a preceptor teaching physical diagnostic skills.

He peppers his colleagues with e-mails, tracks them down by phone and nabs them in the hallway, all in the name of medical education. He likens the process to pulling teeth, but he understands doctors' reluctance.

"There are many faculty who would love to teach, if it wasn't for the fact that their clinical or research loads prevented them from doing that," Dr. Silvestri said. "The research commitment allows them the fastest path to academic success, and the clinical load puts butter on the table."

Doctors such as Dr. Silvestri may find their jobs increasingly difficult as plans to expand medical school enrollment through additional students at existing schools and via new campuses gain momentum.

The Assn. of American Medical Colleges has asked allopathic medical schools, which in 2005 accepted about 17,000 students, to expand that by 30% by 2015.

More students create a need for more physician-teachers at a time when it's already difficult to convince physicians to take on this task, medical educators say.

"This is an area we need to watch closely," said Edward Salsberg, director of the Assn. of American Medical Colleges Center for Workforce Studies. The center "may need to do more to assess and monitor the adequacy of teaching faculty."

Who's in demand

Medical students are exposed to a range of clinical experiences during their educations. At academic medical centers, clinical faculty, who are often subspecialists treating a very specific patient population, might supervise students and residents.

Medical students also need to spend time with community physicians, usually internists and family physicians, who can expose them to patients with more general health concerns, such as strep throat or ear infections. Called volunteer faculty or community preceptors, these physicians are in high demand by existing medical schools and face considerable pressure to generate income and meet the daily office demands.

Richard Cooper, MD, senior fellow at the Leonard Davis Institute of Health Economics, University of Pennsylvania in Philadelphia, said finding community preceptors becomes even more difficult considering that allopathic schools aren't the only ones in need of preceptor sites. Physician offices also are being sought as training grounds for osteopathic medical students, nurse practitioners and physician assistants. Many Caribbean medical schools seek U.S. training sites for their students as well.

"This is a pool of people who are busier and busier," Dr. Cooper said.

Medical schools looking to expand enrollment in a city already dense with teaching hospitals might have a difficult time, experts said, because local physicians willing to teach probably already are.

But it might not be so hard to recruit physician-teachers if teaching were given the status of clinical work or research, experts say. Now it's extremely rare for a physician to get reimbursement for lost patient revenue and there are no career advancements from teaching.

William Taylor, MD, oversees Harvard's course directors. He said the school dedicated a small budget to longitudinal preceptors teaching diagnostic skills, and "it's made a huge difference in recruitment." Clinical faculty, coping with expectations to generate more income or do more research, are more open to giving their time, and Dr. Taylor no longer worries if he'll be able to put the course together each year.

However, schools expanding in new locations might find physicians more receptive to teaching requests because they aren't already overloaded with med students or residents.

The University of Washington School of Medicine in Seattle is one medical school actively adding clinical training sites in untapped areas. New sites are opening in Billings and Missoula, Mont., allowing third-year medical students to choose to complete their required rotations in Montana. The school also has sites in Alaska, Idaho and Wyoming, as part of WWAMI, a five-state partnership aimed at training physicians for practice in these largely rural states.

Family physician Tom Greer, MD, an associate professor with the university, is looking for a new internal medicine, family medicine or pediatrics site in Wyoming for next summer. The state of Wyoming is helping finance two new medical students a year until there are six new students in each class. Dr. Greer's task is to get preceptor sites prepared for these students' third-year clerkships.

He evaluates each potential site in person, then if the physicians and their practices make the grade, the school brings one representative from each site to Seattle four times a year for faculty development.

Participating physicians are asked to take at least eight students a year, so the office staff and patients become used to having students around. It's not a small request in light of declining reimbursements and the pressure to see more patients.

Yet, Dr. Greer has been impressed at how many physicians stick with teaching, despite the additional pressure. "Turnover is not as dramatic as you would think," he said.