National call to action needed to strengthen primary care pipeline in medical education, argue experts

A primary care physician is hard to find. The thousands needed nationwide are even tougher to discover. A new paper led by a faculty member at the Hackensack Meridian School of Medicine (HMSOM) points to why—and outlines strategies to boost recruitment, starting in undergraduate medical education.

The perspective piece in the Journal of General Internal Medicine identifies what the authors call a critical gap in “med ed”: While graduate medical education mandates ambulatory training, neither the Liaison Committee on Medical Education (LCME) nor the Association of American Medical Colleges (AAMC) requires specific outpatient exposure during medical school.

This is a missed opportunity, according to the experts.

The paper was authored by medical education experts on behalf of the Society of General Internal Medicine (SGIM) and Association of Chiefs and Leaders of General Internal Medicine (ACLGIM) Hess Initiative Work Group. The writers were led by Tovah Tripp, MD, associate professor of internal medicine at HMSOM, the school’s internal medicine clerkship director and a practicing primary care doctor at Hackensack Meridian Health.

“Investing in (undergraduate medical education) experiences is essential to rebuild the primary care pipeline and create a generation of physicians who understand the value and role of primary care within the health care system regardless of their ultimate specialty,” the authors write.

The paper synthesizes existing literature into interrelated pathways to boost primary care’s importance to doctors-in-training. First, stimulating the “ecosystem” of primary care through mitigating administrative burdens and debt, while leveraging artificial intelligence and team learning models, will boost the value of the clinical role to learners.

Faculty can also be developed through incentives, including educational relative value units (RVUs) or tax credits, as well as protected time and flexible schedules, among other givebacks. Finally, enriching students’ experiences of primary care during clerkships and mentorships would heighten the value of primary care, they write.

Specialty choices are often solidified long before residency, making early interventions critical, the authors argue. Medical schools and accrediting bodies should mandate minimum ambulatory rotation requirements to ensure primary care choices when the time comes, the authors add.

“There is not a single ‘fix’ for this kind of systemic problem, but well-thought-out strategies can nudge the trend in a positive direction,” said Tripp.

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Gaby Clark

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