Pat Ecklar, MD
Associate Dean for Medical Education at Mount Carmel Health System
The United States faces a critical shortage of primary care physicians, due to a combination of several factors. Reports show that 20% of primary care physicians are over the age of 55; however, no more than 20% of current medical school graduates are interested in a career in primary care. These students, along with residency graduates, find primary care unattractive because of low reimbursement, overwhelming administrative burden and the doctor’s inability to provide the personalized care each patient deserves.
At the same time, these graduates carry, on average, $160,000 in college and medical school debt when choosing a residency. However, only 6% of Medicare and Medicaid physician payments go toward primary care providers — doctors who traditionally make $125,000 to $200,000 per year nationally.
These roadblocks are contributing to a projected deficit of 40,000 primary care physicians by 2020.
Ohio is hoping to affect this pattern in the Buckeye state through a two-pronged approach:
(1) Encouraging medical students to choose primary care — and remain in the state after their training is completed; and
(2) Changing the primary care practice model to a new model of care — the Patient Centered Medical Home (PCMH).
Supporting the first initiative are 50 scholarships of $30,000 each (created through House Bill 198) that will be awarded to second-, third- and fourth-year medical students. For this first year of scholarships in 2013, OSU is expected to receive $210,000. The seven students who receive them must do a primary care residency in Ohio and practice in Ohio for at least three years after their residency is completed.
The second initiative, the PCMH, provides a framework for organizing systems of care at both the micro (practice) and macro (society) level. It is about the patient and team-based care, while maintaining the important patient-physician relationship. The PCMH provides a multidisciplinary team working at the top of their licenses to provide proactive, consistent and coordinated evidence-based patient care. The physician-led team can include nurses, pharmacists, dieticians, social workers, nurse practitioners and physician assistants.
Overall health care costs are reduced in this new model; patients have improved access to care and are not forced to go to emergency rooms or are unnecessarily referred for problems that can be handled at the primary care level. It is a model that focuses on health care — not disease care.
Currently, there are 246 PCMHs in Ohio — and this number is growing. The future awarding of the scholarships previously mentioned will be based on how well each Ohio medical school supports the PCMH model and how many of its graduates go into primary care. It is only in this first year that the scholarships are being divided equally among the seven medical schools.
OSU College of Medicine students enrolled in the LeadServeInspire (LSI) competency-based curriculum are instructed in PCMH principles from the very beginning of medical school. All incoming students are paired with a community physician and work with office-based health care teams to participate in all aspects of patient care. LSI students complete projects that focus on the social issues the PCMH framework hopes to address, such as health care disparities, the specialized needs of patient populations and access to care. OSU’s mission is to prepare students who are measurably excellent in the knowledge, skills and attitudes needed to deliver the highest quality care to a diverse population of patients.
The projected shortage of primary care physicians calls for the need to make the delivery of primary care as efficient as possible and supports the need for incentives to increase the number of doctors going into this field of practice. A total of $1.5 million in annual medical school scholarships and the continued growth of PCMHs are two major steps toward helping Ohio meet the health care needs of its citizens.