Medical schools producing too few primary care doctors

The nation's medical schools aren't graduating enough doctors who practice primary care or work in underserved areas, according to a new study.

A trend toward specialization is particularly worrisome, with increased primary care demands expected due to the health system reform law, said study lead author Fitzhugh Mullan, MD, a professor of medicine and health policy at George Washington University in Washington, D.C.

"That will create more pressures on the system, but particularly on primary care," he said.

The study, published in the June 15 Annals of Internal Medicine, ranked 141 U.S. medical schools, both allopathic and osteopathic, based on their "social mission" -- how well they produce minority doctors, primary care physicians and doctors who go on to work in underserved areas (link).

But critics say the study isn't fair to medical schools. The Assn. of American Medical Colleges said the findings present a "limited picture of how medical schools serve" society.

John Prescott, MD, AAMC chief academic officer, said medical schools should not be ranked. They are complex institutions whose faculty, staff and students contribute to society in many ways, including operating free clinics, providing care in hospitals and generating groundbreaking research.

"Medical schools are not like sports teams. We're not counting wins or losses here," he said.

Dr. Mullan agreed that medical schools do many things to help communities, but he said society is increasingly looking for efficient ways to quantify value.

"The idea that performance won't be categorized and rated is unrealistic," he said.

According to the study, osteopathic schools produced more primary care physicians but fewer minorities compared with allopathic schools. Public medical schools graduated more primary care physicians than private schools.

In general, schools with a large proportion of federal research funding graduated fewer primary care doctors and fewer physicians who went on to practice in underserved areas.

Perry A. Pugno, MD, MPH, director of the American Academy of Family Physicians' division of medical education, said a physician's choice of specialty may be influenced by several factors, including perceived prestige, workload, scheduling and income.

Medical schools can communicate the importance of primary care to students during admissions, in the classroom and with role models, he said.

Dr. Prescott said many medical schools have increased efforts to steer students toward primary care in recent years, as evidenced by a 9% increase in medical school graduates going into primary care residencies this summer compared to 2009.

"I think our schools are doing a good job at encouraging more students to consider primary care," he said.