Julie Phillips, M.D., M.P.H., wears several hats. As an assistant professor of family medicine at Michigan State University College of Human Medicine in East Lansing, she spends 40 percent of her time teaching medical students. Her broad-spectrum clinical practice at the university includes obstetrics and hospital visits, and research rounds out her career.
Considering those interrelated roles, one can understand Phillips' keen interest in finding out what medical students think about primary care medicine. "Even when I'm practicing, I'm with medical students almost all of the time," she told AAFP News Now in an interview about a survey Phillips and her research colleagues launched at three allopathic U.S. medical schools between 2006 and 2008.
The survey was designed to measure medical students' perceptions of the work life of primary care physicians and of subspecialist physicians. The results were published in the January issue of Family Medicine in an article titled "How Do Medical Students View the Work Life of Primary Care and Specialty Physicians?(www.stfm.org)"
The data that Phillips and her research colleagues collected indicate that medical students have negative views of the work life of all physicians and particularly that of primary care physicians.
- Medical students at three schools were surveyed between 2006 and 2008 about their perceptions of the work life of physicians.
- Survey results showed that medical students have negative views of the work life of all physicians and particularly that of primary care physicians.
- Students who completed a family medicine clerkship were less likely to believe that time pressures kept primary care physicians from developing good patient relationships.
"The results were kind of discouraging when I reviewed them," said Phillips. "And I also was surprised that those negative views were there right from the beginning, even in the first-year students. That makes me think that some of their views of what it's like to be a doctor actually don't come from medical school but from the larger cultural perception of what physician work is like -- and especially what primary care is like."
The study researchers distributed questionnaires to 1,533 students at Michigan State University College of Human Medicine in Grand Rapids and East Lansing, the University of Michigan Medical School at Ann Arbor, and Warren Alpert Medical School at Brown University in Providence, R.I. A total of 983 surveys were returned, for a response rate of 64.1 percent.
Survey data show that 11.2 percent of first-year students and 10.8 percent of second-year students indicated an interest in pursuing primary care careers, and slightly more than 18 percent of third-year students and 21 percent of fourth-year students showed an interest in primary care. Overall, nearly 15 percent of survey respondents were planning primary care careers.
To gauge the students' views of work life for physicians, study researchers used a 5-point Likert-type scale and instructed students to agree or disagree with parallel statements about primary care physicians and subspecialist physicians. Statements covered topics such as physician autonomy, administrative work and patient relationships.
Overall, students' responses to statements about primary care and subspecialist work life were negative. Students generally agreed that
- physicians spend too much time on administrative work and are pressured by the pace of work, and
- payers restrict quality of care and conflict with physicians' clinical judgments.
However, although the student respondents viewed primary care physician work life more negatively than that of subspecialists, a majority of them indicated that relationships between primary care physician and their patients were less adversarial than those between patients and subspecialists.
The researchers also noted that third-year students who had completed a required family medicine clerkship were less likely than third-year students who had not finished the clerkship to think that time pressures kept primary care physicians from developing good patient relationships.
"It may be that actually spending time observing physicians helps to break some negative stereotypes," wrote the authors, citing a previous study in which students "reported that physicians did not appear rushed with patients ... students indicated their own surprise about how frequently the physician spent a considerable amount of time with individual patients."
The authors noted that some students in the survey sample were interested in primary care regardless of their negative views of primary care physicians' work life and suggested that those students' career plans were based on values and goals rather than perceptions. "The study reinforces the importance of admitting students with primary care-oriented values and primary care interest," the authors concluded, adding that those values need to be reinforced during medical school to increase the number of primary care physicians.
Phillips' objective was to produce quantitative evidence about how medical students view the daily work activities of both primary care physicians and subspecialists. Having achieved that with the study, she urged primary care physicians to turn the sobering findings into a positive game plan.
"We shouldn't feel hopeless," said Phillips. "We are in the process of reforming our model of care, and this study gives us more reason to do that." She challenged physicians to support new models of care, such as the patient-centered medical home, and to work for payment reform. Doing so "will make primary care work life better and make primary care more attractive to students," she said.
In addition, Phillips urged family physicians to share the good things about their specialty choice with students. "Students listen to what we say. We should try to be positive about the great things in our everyday work, because there are many wonderful things about being a family physician," she said.
Phillips said she also wondered if a similar survey conducted after the passage of the Patient Protection and Affordable Care Act would garner more positive responses, particularly about practicing primary care medicine.
"It's hard for me to say, of course, but I would hope it would be better; my sense is that the students are more interested in primary care and more interested in public health," said Phillips. "Health care reform has made primary care more discussed in the popular media, and I think students are more aware of physician workforce issues because of that."