United States allopathic medical schools (those that offer the degree of MD) graduate over 18,900 MDs a year. After graduation, the young doctors choose what specialty to follow. Osteopathic medical schools (those that offer the degree of DO) graduate another 5,300 DOs.
Many different evaluations of quality health care have shown that having a strong primary care program of family physicians or generalists in internal medicine, obstetrics-gynecology (OB-GYN), and pediatrics offers better health to a population than having many secondary specialists such as surgeons, radiologists, and other sub-specialties. Those states in the USA with the most generalists and the fewest specialists have the best health profiles for their citizens. In other words, the more primary care physicians we can have, the better for our nation’s health.
The problem for young doctors deciding which residency to take is that in general primary care, physicians do not earn the same high salaries as some of the subspecialties. Brain surgeons, cardiac interventionists, oncologists, and dermatologists tend to earn more or have better working schedules than primary care providers. For the young physician who may graduate from medical school with a half-million-dollar debt to pay off during the next 30 years of practice, to sub-specialize and not generalize is a real temptation. Also in hospital-based medicine the highly-trained, highly-compensated sub-specialists tend to have higher status than “just a family doctor.”
In an ideal world US medical schools would produce at least 40% primary care graduates, and in an ideal world their compensation as first line and highly valued members of the health care team would be as much as or more during their careers than the compensation for less demanding sub-specialties.
The reality is that only 8.7% of the 138 US MD-granting medical schools and 15.5% of 32 DO-granting medical schools choose family medicine. So on January 9, 2017, John Meigs, MD, President of the American Academy of Family Physicians, sent a letter of congratulations to the top 21 allopathic medical schools for encouraging family medicine choices for their residencies.
The top MD-granting school was the University of Minnesota Medical School in Minneapolis, with 19% of their graduates entered in a family medicine residency program. Also receiving a letter of commendation from Dr. Meigs was Loma Linda University School of Medicine, 6th in the list of 20 Top Schools, with 16.5% of their graduates choosing family medicine residencies. This is as good as or better than at least half of the 32 DO-graduating medical schools.
Adding the other primary care specialties (such as general internal medicine, pediatrics, OB-GYN), while not reaching the 40% goal, at least means some medical schools are doing a better job of meeting the health needs of the USA than others. Loma Linda University School of Medicine and their dean Dr. Roger Hadley are to be commended for being one of the leaders in training doctors to meet the nation’s needs instead of just graduating physicians looking for a quick pay-off on the considerable investment they made in their education. The challenge for the US health-care system is how to make medical education more affordable for doctors wanting to become family physicians or other primary care specialties. Subsidies or debt repayment programs need to be budgeted into the national health care budgets for primary care providers. Adventist educators need to be aggressive in looking for funding to provide the kind of doctors interested in long-term whole person care that can be more of a mission than a business. And in having patients who become friends instead of just customers. Some of us will need a good specialist physician at some time in our lives; they are very valuable. But all of us need enough primary care doctors for our birth-to-death lifelong health care needs. And Seventh-day Adventist doctors with a sense of calling or mission to their profession often do an excellent job of that.– JBH.
(Data for this item found in: https://www.stfm.org/FamilyMedicine/Vol48Issue9/Kozakowski688 and https://www.aafp.org/news/education-professional-development/20170109topschools.html .)