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Monday Apr 01, 2013

Primary Care Physician Shortage Requires Bold Action

If we build it, they will come.

For the first time in more than 100 years, a new medical school will open this summer in Indiana. Marian University's College of Osteopathic Medicine has a decided focus on primary care. The dean, the associate dean and two of the trustees -- including  me -- are family physicians. We have taken a deliberate approach to screening, looking for students who not only have an interest in primary care but who also are interested in staying in the Hoosier State to practice medicine. We hope the new school will produce more than 90 primary care physicians per year, starting in 2017.

Student interest in the school has been encouraging. For the 150 spots available in Marian's first class, we received more than 3,200 applications.

This effort is an important step in addressing a glaring need. Indiana University's School of Medicine, the state's only med school (until now), boasts the nation's second-largest student body, but the school has not produced enough primary care doctors to meet demand.

That demand is going to increase dramatically in the near future as veteran physicians retire, the Patient Protection and Affordable Care Act expands access to health care and an aging baby boomer population becomes eligible for Medicare. By 2020, the state is expected to face a shortage of 2,000 primary care physicians.

Health care leaders in my state are well aware of the need, and opening a new med school is one strategy to address it.

Indiana isn't alone. The United States is facing a shortage of 45,000 primary care physicians by the year 2020. Marian is one of three osteopathic med schools opening this year, and more than a dozen new allopathic medical schools are in various stages of development.

Of course, it won't do much good to churn out more medical school graduates if we don't also increase the number of residency slots available. Although there are bills under consideration in Congress that would increase the number of Medicare-funded residency positions, there is no guarantee that such legislation will produce more family physicians.

Here in Indiana, we're taking steps to do just that.

Marian -- a small Catholic school in Indianapolis -- won't offer a residency program, but the new medical school has partnered with two hospital systems that do. St. Vincent Health is a network of 20 hospitals, and Community Health Network has eight. (I am the chief medical officer of the latter.)

Community Health Network has two family medicine residencies -- one allopathic and one osteopathic. We recently expanded our allopathic residency from seven slots per class to eight per class.

We also successfully applied and received CMS funding for 22 additional residency positions. We now must decide whether to expand our existing programs or develop a new residency program. Whichever way we decide to go, we need to act quickly before Marian's first class graduates in 2017.

It's becoming increasingly clear that it will take bold action and creative thinking to address the looming physician shortage. What is happening in your state?

Clif Knight, M.D.is a member of the AAFP Board of Directors.


2 comments: 1.It will be 2020 before you can prove ultimately how many graduates went into primary care and not subspecialties. 2.According to the website the total cost of attendance is $65,000/YR Good Luck!

Posted by Louis Spikol on April 02, 2013 at 07:15 AM CDT #

Actually you know what you get in future primary care from the first match. ATSU SOMA had 30% family medicine in 2011 and 2012 grads. Osteopathic has fewer IM (only 30% PC) and the PD or MPD is small. Family medicine is good for 90% primary care or 80,000 visits for a career. . SOMA has only graduated 2 classes, yet has 10 Standard Primary Care Years per graduate for these two classes and SOMA grads will average about 35,000 primary care visits in their careers. Osteopathic averages about 8 and Allopathic about 4 with elite schools and advanced practice nursing at just 2 SPCYrs or 8000 primary care visits during their career (2 years visits for an FM doc). You cannot graduate enough numbers from low yield primary care training to result in sufficient PC. . This 10 SPCYrs is at the top of DO outcomes and compares to the average pediatric residency graduate and is 3 times the primary care visit level of an NP or PA or IM graduate. . As a leader, I would hope that you will make Marion into a 6 or 7 year combined med school and Accelerated FM residency training so that you can have commitment to 80,000 visits at the time of admission when they commit to FM. Since you will train them entirely in FM in FM practices, you will have the optimal design. Your students and residents will make your practice sites even better. . This accelerated design will result in over 70% instate, over 60% in the same first practice location, and over 40% in rural locations as my research is showing on accelerated grads of the 1990s. There is no reason not to have 100% accelerated FM grads from admission to retirement. . We have added 30 FM positions to link with our CHC training via the Wright Center and HRSA but more is desirable for the 200 million behind in health access in our nation in 30,000 zip codes - locations and populations only served well by over half of FM docs - because we stay over 90% in employed family practice by design.

Posted by Robert C. Bowman, M.D. on April 03, 2013 at 12:52 PM CDT #

The future of Family Medicine will not involve keeping up a certain number of office visits.We will need to treat/interact with a significant part of our practices outside the office environment.This will involve significant innovation and a change in conventional thinking.

Posted by Louis Spikol on April 03, 2013 at 03:54 PM CDT #

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