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Wednesday Dec 11, 2013

Student Audience at Vanderbilt Gives Hope for Primary Care

As I have often said, one of the great joys of being an AAFP Board member is the opportunity to attend chapter meetings and talk to members from across the country. Every now and then, however, I receive an even more special invitation.

I recently was asked by the family medicine interest group (FMIG) at Vanderbilt to come speak during the medical school's Primary Care Week. It is nearly impossible for me to turn down a request from students, especially those from one of the 11 target schools that lack a department of family medicine.

Although Vanderbilt does not have a family medicine program, there are a number of family physicians in the region who have worked hard to give its students role models and mentors in our amazing specialty. I was honored to add my name to that list. Some students from Meharry Medical College -- another Nashville, Tenn., school -- also were  present, but the majority of students were from Vanderbilt.

This was an outstanding experience. We had almost 100 students (including student leaders Eszter Szentirmai, Josh Hollabaugh, Allison Umfress and Ashlee Hurff, who are pictured here) who were interested in primary care and the role that it will play in the future of health care. I took the opportunity to tell my own story, which began at a time when my own alma mater -- Emory University -- lacked a family medicine department. My path was similar to theirs.

I was able to talk about the excitement of finding family medicine while at Emory and nurturing that experience to become a small town family physician. One of the messages that I gave students was to make sure they keep doors open and consider all possible career choices.

We talked about some of the challenges that stop students from picking primary care. For example, at some schools, students interested in primary care sometimes are told they are too smart for family medicine. That is an interesting comment. If anything, someone choosing family medicine is recognizing his or her ability to see everything broadly and doesn’t feel the need to be limited to a particular organ system, body part or group of diseases.

There is no question that these students made a choice and followed a calling into medicine because they want to help people. No specialty can help people as broadly and as immediately as family medicine.

They also were interested in advocacy. We talked about some components of the Patient Protection and Affordable Care Act and how it has provisions that provide incentives for primary care.

We talked about the need to come up with different payment models to support this transformation. We discussed the real need for hospitals to change their structure to be part of new models of care such as accountable care organizations, instead of focusing on keeping their beds full to maximize profits.

We talked about the role of physician-led teams in taking care of all patients and meeting the depth of their needs in this changing time, especially as patients with multiple chronic diseases become more complicated to manage. More patients than ever are presenting with comorbidities. As family physicians, we are at the front lines of managing this care, and we have the ability to make the greatest impact in patients' lives by managing their health at the earliest stage possible.

This also was a great opportunity to talk with students, many of whom are graduating in 2016 and 2017, about the disparity between the number of U.S. medical students who will be graduating and the number of residency positions that will be available. There was no question that reality is starting to sink in, and these students were interested in how they could advocate for change.

I told them that as medical students, it is critically important for legislators to hear their voices, and I assured them that representatives with medical schools in their districts will want to hear from them. I challenged them to reach out to their legislators, whether by email or a personal visit to their offices.

I am confident that Tennessee's representatives in Congress will be hearing from some of these students.

Having students from both Meharry and Vanderbilt created an interesting point of comparison.  Here I was talking about primary care in a target school that ranked at the bottom of medical schools in an Annals of Internal Medicine article that evaluated schools in terms of addressing the social mission of meeting a community's needs. On the other hand, Meharry ranked second in that report, which considered the percentage of graduates who practice primary care, work in health professional shortage areas and are underrepresented minorities. 

Based on the AAFP's annual study of family medicine residency matriculation rates, Meharry ranked 23rd in 2013 with 13.8 percent of students matriculating to family medicine residencies, and Vanderbilt ranked 126th (last) with 0.3 percent of students matriculating to family medicine residencies. These figures are based on a three-year rolling average calculated annually by the Academy.

The fact that we had students from both ends of the spectrum expressing an interest in primary care gives me hope that we can continue to open doors and make inroads. Family medicine is all about relationships with patients, but it also should also be about relationships between students in different schools sharing a culture and philosophy, and between students and those of us who are in regular practice. The more we can create and nurture these relationships, the more likely our students will recognize the path to family medicine is truly the one that allows them to follow their heart and fulfill their dream of helping people and changing the world.

Family physicians interested in reaching out to their local FMIGs to see how they can support those groups may contact AAFP student interest strategist Ashley Bentley

Reid Blackwelder, M.D., is President of the AAFP.

Comments:

Thank you so much for coming to speak to us at Vandy, Dr. Blackwelder! We really enjoyed having you here and hearing about your background of training at an "orphan school" yourself. As the lone 4th year student going into FM this year, I am extremely proud to represent that 0.3%. I am even more excited though about all of the comments I received from current 2nd and 3rd year students after your talk. Based on what they were saying, I think that 0.3% will be increasing in the coming years as more students realize the incredible opportunities available in primary care, and particularly in FM! I think I speak for the entire Vanderbilt FMIG when I say thanks again for all of the support that you, the TNAFP, and the AAFP offer to us! We really do appreciate it!

Posted by Jennifer Rahn on December 26, 2013 at 03:19 PM CST #

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