Each year, approximately 20,000 students complete their medical school training in the United States and transition into residency programs. However, only a fraction of these new physicians—fewer than 7,000—will dedicate their careers to primary care. The Association of American Medical Colleges projects that the nation faces a shortage of up to 43,100 primary care physicians by 2030.
Primary care physicians serve as the backbone of our healthcare infrastructure. They identify disease, manage ongoing health conditions, and connect patients with specialists when necessary. Without them, the American healthcare system would become even more fragmented and difficult for patients to navigate.
Financial incentives and professional prestige drive many medical graduates away from primary care. Specialists command higher salaries and often engage in cutting-edge research that enhances their standing in the medical community. Between April 2016 and March 2017, Merritt Hawkins, a physician recruitment firm, handled nearly 3,300 searches for clients. Recruiting an orthopedic surgeon came with an average offer of $579,000, compared to less than half that amount for family practitioners.
Faculty composition at medical schools reinforces this trend toward specialization. Surgery departments employ more than 15,000 faculty members across U.S. medical schools, while family practice departments have only 5,700. Students naturally gravitate toward the specialties represented by their professors, whom they view as mentors and role models.
Training locations also steer students away from primary care. Most medical education occurs in large teaching hospitals where patients arrive after referral from other providers. Small clinics and private practices see relatively few medical students. Yet the reality is that most American healthcare—particularly primary care—happens outside hospitals. Physicians see 923 million patients annually in office settings compared to 130 million emergency department visits, with primary care accounting for more than half of all office visits.
This mismatch leaves students without adequate exposure to primary care to make informed career choices.
Solutions exist despite these substantial obstacles. Medical schools can actively recruit students into primary care by establishing new training pathways. In 2015, the University of California, Riverside’s medical school worked with Desert Regional Medical Center and Desert Healthcare District to create a primary care residency program in Palm Springs. UC Riverside additionally collaborates with Loma Linda University on the Pediatric Primary Care Residency Training Program, which trains residents for careers in pediatrics and family medicine.
Schools should also create opportunities for students to work in community settings. At the University of California, Davis, School of Medicine, nearly nine in 10 students volunteer at clinics serving underserved populations. This exposure has yielded results: half of UC Davis students chose primary care residencies in 2015.
Financial support represents a third lever. St. George’s University, located on the Caribbean island of Grenada, operates the CityDoctors Scholarship program, which awards grants to New York City students who pledge to work in the city’s public hospital system after graduation. Eight students received CityDoctors scholarships this year totaling $1.1 million.
For the physician workforce to meet America’s healthcare needs, medical schools must make primary care both attractive and financially accessible to the next generation.
- Richard Olds, M.D., is president of St. George’s University. He was founding dean of UC Riverside’s medical school.