Many U.S. Medical Schools Give Boost to Primary Care as They Increase Enrollments

U.S. medical schools are on track to meet the 30 percent increase in first-year medical school enrollments called for in 2006 by the Association of American Medical Colleges, or AAMC. And many of those positions likely will be filled by students interested in primary care.

According to the report Results of the 2010 Medical School Enrollment Survey (13-page PDF; About PDFs) from the AAMC Center for Workforce Studies, combined first-year enrollments at 134 U.S. medical schools with full or preliminary accreditation, plus seven "candidate" medical schools, likely will meet the 30 percent goal as early as 2016.

The report is based on the seventh annual survey of deans of U.S. medical schools accredited or preliminarily accredited by the Liaison Committee on Medical Education. The report found that first-year medical school enrollment has increased from 16,488 students in 2002 to 18,665 in 2010, an increase of more than 13 percent. In addition, enrollment is expected to increase an additional 28 percent by 2015.

"There can be little doubt that the medical education community has risen to the challenge of achieving the (recommended) 30 percent growth in first-year enrollment," the report says. "Whether by 2015, 2016 or 2017, it currently appears that the goal will be met."

The news is particularly good for family medicine and primary care. Seventy-five percent of the medical schools questioned have current or future plans to institute programs or policies to encourage student interest in primary care, including new or expanded elective clinical rotations, refined admissions criteria, modified required clinical rotations, modified preclinical curriculum, expanded primary care faculty and/or resources, and new or expanded extracurricular opportunities.

Many of the medical school deans answering the questionnaire, however, also expressed concern about the supply of student clinical clerkship positions and qualified preceptors, especially primary care preceptors, needed to meet the increased number of medical students.

According to Perry Pugno, M.D., M.P.H., the AAFP's vice president for education, there are other trends that could affect the numbers, as well. For example, "We need to encourage the medical school deans to stop counting all students who enter family medicine, internal medicine and pediatrics residencies as indicative of those seeking careers in primary care," he said. "We know very well that the vast majority of those entering internal medicine and pediatrics residencies will eventually gravitate toward subspecialty fellowships and not primary care."

Pugno added that he is hopeful that "the new medical schools, in particular, will ensure that their primary care initiatives truly encourage medical students toward practices in family medicine, general internal medicine and general pediatrics."

Enrollment numbers at osteopathic medical schools also are increasing, according to the AAMC report. From 2002 to 2010, first-year enrollment at schools in the American Association of Osteopathic Colleges of Medicine increased from 3,079 students to 5,233, a 70 percent increase.

By 2015, allopathic medical and osteopathic schools will have a combined enrollment increase of 35 percent, producing almost 7,000 more new doctors every year compared with the number produced in 2002, says the report.

However, the report's authors also recommend continuing to monitor trends in medical school enrollment, particularly as health insurance coverage expands because of the Patient Protection and Affordable Care Act, which likely will create a need for more physicians.

In addition, the report found that more schools in 2010 than in 2009 -- 52 percent versus 39 percent -- expressed concern that the current economic environment will limit their ability to maintain or increase enrollment.

Pugno agreed. "I am indeed concerned that the limits to expansion of GME (graduate medical education) positions, as well as the nation's economic pressures on residency education, will hamper the efforts to increase the production of primary care physicians.

"We truly need a program that will leverage the opening of new, primary care GME positions preferentially."