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Medical Students Aware of Downside of Daily Physician Grind, Study Shows
Author Urges FPs to Use Study Results as Springboard to Action
By Sheri Porter
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?" (7-page PDF; About PDFs).
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.
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.
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.
"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."