STFM Conferees Discuss Ways to Fill Family Medicine Pipeline

Filling the primary care pipeline is all about the numbers.

It's about the numbers of

Taken together, those numbers provide grist for efforts by the Society of Teachers of Family Medicine, or STFM, to advocate -- on institutional, state and federal levels -- policies that encourage students to enter primary care. STFM members shared their initiatives for addressing pipeline issues during the STFM Annual Spring Conference here April 24-29.

Since 2003, studies have documented a growing shortage of primary care professionals and the impact of that shortage on access to care, said Janice Benson, M.D., associate chair of the department of family medicine at John H. Stroger Jr. Hospital, Chicago, during her presentation, "Unclogging the Pipeline: Problems and Solutions to Improve the Quality of the Family Medicine Workforce."

Benson pointed to research published by the AAFP's Robert Graham Center in Washington in 2004; studies by the Council on Graduate Medical Education and the American Academy of Pediatrics, or AAP, in 2005; and reports by the AAFP and the American College of Physicians in 2006. All document a need for primary care and family medicine, she said, adding, "The AAP even discussed overtly the issues of how family physicians are important to the care of children."

Now, the "family of family medicine" needs to spread the word that "family medicine is important because family physicians distribute to underserved areas," said Joshua Freeman, M.D., professor and chair of the department of family medicine at the University of Kansas School of Medicine, Kansas City, during the seminar. "They're the ones who take care of people where there are no other doctors."

Ensuring a full family medicine pipeline requires a comprehensive approach that includes

"We know the characteristics of students who will go into family medicine. We know the programs that work. Now we need to do it," said Benson.

The ideas on how to fill the pipeline abounded. Among them were working with state legislatures to advocate support of scholarship and loan forgiveness legislation. Speakers pointed to recently passed Kansas legislation that allows second-, third-, and fourth-year medical students to apply for and retroactively receive tuition and a monthly stipend of as much as $2,000, an increase from the previous $1,500.

Another idea voiced was to participate in medical school admissions committees and advocate policies that reduce emphasis on Medical College Admissions Test, or MCAT, scores and grade point averages and that focus in admitting students likely to go into primary care.

MCAT scores and grade point averages have little relationship to the quality of the physician, said Freeman.

"If quality is defined as having high grades and exam scores, forget it," he said. "We should be looking at what the applicants have done. Have they worked with the Peace Corps or VISTA (Volunteers in Service to America)? What they wrote on an essay is nonsense. It's what they've done that matters."

Another proposal was to work with state legislators and medical schools to implement or expand rural scholars programs that target students in rural and underserved areas.

"We know these programs work," said Freeman. "There are just not enough of them."

Benson agreed. "If you get students who grew up in rural areas, they are much more likely to go into family medicine and to serve in rural communities," she said. "If you get the right students in there, we'll get the right doctors out to care for our rural population."

The challenge, said these educators, is ensuring these students get into medical school and choose family medicine.

To meet that challenge, family medicine educators must foster leadership within their own ranks, their own departments and their own schools, said Terrence Steyer, M.D., chair of the STFM Legislative Affairs Committee and assistant professor of family medicine and program director for the medical transitional year residency at the Medical University of South Carolina, Charleston.

"To do any of the initiatives (included) in the Future of Family Medicine (Project report), we've got to establish key leaders," Steyer said in an interview. "We have some out there now, but it's time to train a new generation of leaders. We need to show family medicine faculty how to be effective leaders so they can teach their students to be leaders."

To that end, STFM has taken steps to establish a leadership center that will provide resources that help train family medicine educators in institutional, community and public advocacy leadership.

The center will complete a leadership needs assessment, and then develop a program that will train family physicians in leadership skills and legislative advocacy, Steyer told participants during his presentation, "Priming the Pipeline, Preparing for the Future," at the STFM conference. After training, physicians and educators can continue developing strong departments of family medicine and effectively advocate for local, state and federal legislation and policies that support family medicine education.

STFM already has posted information about family medicine-related leadership training opportunities on the STFM Web site, including such opportunities as the Annual Leadership Forum, the Family Medicine Interest Group Faculty Advisor Summit and the Association of Departments of Family Medicine Fellowship.

"STFM has taken this on because, in order for other efforts -- especially pipeline efforts -- to be successful, we've got to train leaders who can go out and develop pipeline initiatives," said Steyer.