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UNC School of Medicine tries to fill primary care gap

More graduates focusing on specialized care, out-of-state careers

A national shortage of primary care doctors leaves universities asking how to lure medical school students away from seemingly more lucrative specialist careers to meet the growing demand.

Without access to primary care in the form of family or general practitioners, emergency rooms and specialists’ offices are being crowded by people looking for care wherever they can, contributing to rising health care costs.

UNC’s School of Medicine is now working to attract students to pursue careers in primary care as opposed to more prestigious careers in specialized care.

At the last Board of Governors meeting, the N.C. Area Health Education Centers Program presented a report on the progress of N.C. graduates entering primary care.

“The number going into family medicine is steadily declining and that’s where you get your biggest pay-off in primary care,” said Dr. Tom Bacon, the executive associate dean of the medical school and the director for the program.

Bacon said half of UNC’s class of 2010 made the initial choice to enter primary care, compared with 56 percent at East Carolina University’s Brody School of Medicine.

“This is very good nationally,” Bacon said.

According to state law, primary care includes family practice, internal medicine, pediatrics and obstetrics-gynecology.

UNC’s medical school aims to expose its students to the opportunity of family care early and to provide incentives for choosing a family medicine practice residency.

“We make it easier for them to go into primary care with family medicine residency programs,” Bacon said.

“It exposes them earlier on to some role models who are in community practice, and the hope is that it will interest some students in a career of that type.”

The expansion of the medical school to campuses in Charlotte and Asheville will allow for a greater push for primary care training.

Although the percentage of UNC school of medicine graduates initially going into primary health care is relatively high, it is not representative of their final career choice.

Of the UNC medical school’s class of 2004, 64 percent entered residency with the initial choice of entering primary care.

But by 2009, that number was reduced by more than half, to only 31 percent.

“Where we lose a lot of people are those who choose internal medicine,” he said, referring to primary care exclusive to adults.

“What has happened in the last ten years or so is that almost 90 percent of the graduates who enter internal medicine go on to sub-specialize into cardiology or gastrology diseases of the digestive tract,” Bacon said.

Another struggle is to keep these students in the state post-graduation.

Of the class of 2004, only 15 percent of graduates are practicing primary care in North Carolina.

The plan is to make sure medical students get in-state residencies, so they are more likely to stay in-state for the long run, said Alan Mabe, senior vice president for academic affairs of the UNC system.

The public schools carry more responsibility for graduating North Carolina’s doctors because the expectations are different for private schools.

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“Duke and Wake Forest tend to have a larger national student body and a huge portion of those leave state,” Mabe said.

The 1993 session of the N.C. General Assembly set the goal for 60 percent of public medical school graduating classes to enter primary care.

“But it’s not strong scientific evidence to say ‘x’ should be in primary care,” Bacon said.

Universities are battling a whole stigma in getting graduates to switch preferences.

Graduates choose to specialize for the higher income, the lifestyle of a specialist and the prestige of being a specialist, he said.

“This is compounded by a lot graduates coming out of med school with high levels of debt,” Bacon said.

The shortage of primary care might contribute to other issues in the health care system, like Medicaid wait times.

“It’s because of a lack of services you might see somebody end up in an emergency room,” said Jennifer Bills, a staff attorney for Disability Rights North Carolina.

The organization works with patients who have physical or mental health problems.

The emergency room becomes the place of primary care for such under-served populations, Bills said.

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