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Wednesday Nov 12, 2014

Home Grown: South Carolina Schools Work Together to Address Primary Care Shortage

As a new physician, I sometimes reflect on whether or not primary care was the right choice for me. Over and over, the answer always is yes. Unlike many of my peers, I was a "late bloomer" in choosing family medicine. I started medical school with plans to be an OB/Gyn, and it wasn't until my fourth year that those plans changed.  

That year, I worked in Ecuador for six months, and that's where I finalized my decision to pursue family medicine. I worked on labor and delivery while I was there, but I also taught rural high-school students about sexually transmitted infections and nutrition. And I worked with a rural physician who saw men, women and children in a remote mountainous area called Cacha. Through that experience, I realized that I enjoy caring for all types of people -- from newborns to the elderly -- and that being able to influence mothers meant influencing the entire family.  

Courtesy University of South Carolina School of Medicine

Students at the University of South Carolina School of Medicine listen to a lecture. The school is collaborating with another medical school, a nursing school, and a physician assistant training program to expand the state's primary care workforce.

There are students who are in medical school right now, or even pre-med students still in college, who also might choose family medicine if they had the right experience or exposure to our specialty. How do we reach those students? And how do we keep the interest of those who decided early that primary care was right for them?

According to research by the Robert Graham Center(www.graham-center.org) for Policy Studies in Family Medicine and Primary Care, the United State is expected to need an additional 52,000 primary care physicians by the year 2025 to care for an aging and growing population, as well as for the rapidly expanding number of patients with health insurance. The situation is particularly grim in my home state of South Carolina, which ranked 40th(www.aamc.org) in the number of primary care physicians per 100,000 people in 2012, according to the Association of American Medical Colleges.

The South Carolina Area Health Education Consortium has responded to this shortcoming by developing the Institute for Primary Care Education and Practice(www.scahec.net) through a grant from the Duke Endowment. The institute is an interprofessional collaboration between two medical schools, a nursing school, and a physician assistant training program designed to increase the number of health professionals practicing primary care in South Carolina.  

The institute recruits first- and second-year medical students, nurse practitioner students, and physician assistant students to become fellows. These health professions students participate in monthly seminars focused on pertinent topics in primary care and an annual retreat with keynote speakers, and they have the opportunity for longitudinal precepting opportunities with primary care physicians, nurse practitioners and physician assistants. The seminars are held via video conference so that students at all the campuses -- which are more than 100 miles apart -- can interact with each other and the seminar speakers.

The institute is in its third year of funding and has experienced success in recruiting dozens of interested students into the fellowship. Many of the nurse practitioner and physician assistant graduates have remained dedicated to primary care as their career choice. This will be the first year of the program that fellows graduate from medical school, so we will have Match data available in the spring to help us gauge our progress.  

It has been an exciting time participating in the institute as a core faculty member and being able to influence so many young health professionals.  

I encourage family physicians to look for ways to foster the next generation of primary care physicians, regardless of whether your primary job function is as an educator. Students need the opportunity to see what we do in our practices across multiple settings, beyond the walls of an academic health center. You may not have a grant to support a project exactly like ours, but you can precept and show the joys we experience in practice as family physicians.

At medical schools, family medicine interest groups can collaborate in a manner similar to the way our South Carolina program works with multiple campus locations, extending limited resources and forming alliances across the state. The AAFP's FMIG Network can help with the tools to build those connections and support your work.

Meshia Waleh, M.D., is an assistant professor of family and preventive medicine at the University of South Carolina School of Medicine in Columbia.

Posted at 02:06PM Nov 12, 2014 by Meshia Waleh, M.D.

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