There's no denying that America needs more primary care physicians eager to work in underserved areas across the country. In fact, according to a new report from the Association of American Medical Colleges (AAMC), an estimated 105 million people live in areas designated as Primary Care Health Professional Shortage Areas.
Since 1997, the University of California-San Diego (UCSD) School of Medicine's Student-Run Free Clinic Project has given medical students like Sean DeWolf, shown here in 2013, the opportunity to care for underserved patients including Gloria Sedano.
Authors of the February edition(www.aamc.org) of AAMC's Analysis in Brief explored the various factors that feed into medical students' commitments to settle down and practice medicine in underserved areas after completion of their medical training.
"Producing a physician workforce that is willing and able to practice in underserved areas is important to the improvement of population health and access to quality health care," wrote the researchers.
They found that free clinic experiences could be a game changer in the equation.
"While student intent to practice in underserved areas at matriculation is a major predictor for an intent to do so at graduation, this study shows that students with exposure to free clinics during their medical school education are more likely to become or remain committed to practice in underserved areas," researchers said.
Just the Facts
Researchers pulled data from two AAMC sources -- the Matriculating Student Questionnaire and the Medical School Graduation Questionnaire -- and studied responses to questions about students' intentions to practice in underserved areas following completion of medical training.
- New research from the Association of American Medical Colleges shows that medical students exposed to free clinic settings during training are more likely to practice in underserved areas.
- Researchers found that all 131 U.S. allopathic medical schools with 2014 graduates offered their students work experiences in free clinics, and 75 percent of those students reported having such an experience in 2014.
- Student participation rates varied widely among those medical schools -- from a low of 15 percent participation to a full 100 percent involvement by students.
Specifically, they looked for any link between "exposure to free clinics during medical school and changes in student intentions at the end of medical school."
Authors found that all 131 U.S. allopathic medical schools with 2014 graduates offered their students work experiences in free clinics, and 75 percent of those students reported having such an experience in 2014.
However, the student participation rates varied widely among those medical schools -- from a low of 15 percent participation to a full 100 percent involvement by students.
Authors also noted this unfortunate statistic: "Students' intentions to practice in underserved areas at the end of their medical school education have remained at or below 30 percent since 1998."
AAFP News contacted the AAMC authors with additional questions about their research. Their comments are summarized in answers provided by AAMC Director of Public Health Initiatives Malika Fair, M.D., M.P.H.
Q. Why is this topic of student free clinic experiences important in the context of physician workforce issues?
A. There continue to be parts of the country that face difficulty recruiting and retaining physicians for a variety of reasons. Without a reliable health care workforce, it can be a challenge for patients in those communities to access the health care services that they need, resulting in potential health disparities. These challenges only will increase as the aging population leads to substantial physician shortages nationwide, especially since physicians are aging, too.
We need a comprehensive, multi-faceted strategy to address workforce needs across the board. One important component will be to better understand the various factors that go into a physician’s decision to practice in an underserved community.
Q. What do you want readers to take away from these research results?
A. Medical schools are committed to preparing the next generation of physicians to address the country’s most pressing health care challenges, including access to health care in underserved areas and helping to address health disparities. This analysis shows that students at all 131 medical schools graduating students in 2014 had opportunities to participate in free clinics, and those experiences appear to enhance or inspire an interest to practice in underserved areas.
By offering educational opportunities in a diverse array of settings throughout the community, medical schools are both strengthening the physician workforce and responding directly to the community’s health care needs. While there are numerous personal and complex factors that drive physicians’ ultimate practice choices, medical education provides students with wide-ranging experiences to help inform those choices.
Q. Although free clinic experiences were available to students at all medical schools, participation rates varied widely among those schools. Do the researchers have any suggestions on how to increase student involvement across the board?
A. Participation rates may depend on both the availability and quality of opportunities at particular institutions as well as the interest level of the students. Establishing free clinic opportunities for students can require faculty members and medical schools to engage with community partners.
Strong faculty preceptors can support students as they explore both the clinical and population/public health aspects of their experiences. Other types of community-engaged activities, such as partnership with local public health agencies or community-based organizations, may also help to prepare and interest students to care for underserved populations.
Related AAFP News Coverage
Robert Graham Center Research
Teaching Health Center Residencies Help Underserved Areas
HHS: Health Professional Shortage Areas(bhpr.hrsa.gov)