Where Supply Meets Demand: Why Medical Students Should Aim Their Sights at Primary Care
Italo M. Brown, MPH, is a third year medical student at Meharry Medical College. He holds a BS from Morehouse College, and an MPH in epidemiology and social and behavioral sciences from Boston University, School of Public Health. He is a Health Policy Scholar at the Robert Wood Johnson Foundation Center for Health Policy at Meharry Medical College.
In an ad-hoc poll among classmates, I recently inquired about the most important date (in 2013) to a second year medical student. The overwhelming majority of respondents cited their respective STEP 1 exam dates as most important, followed closely by the season finales of ABC’s Scandal and Grey’s Anatomy. While the top three responses are noteworthy, the one date that should bear the most gravity in the minds of medical students across cohorts is October 1st.
This October marks the launch of open enrollment for health insurance exchanges, a much-anticipated provision of the Affordable Care Act (ACA). The ACA seeks to reduce the number of nonelderly uninsured Americans by half; in other words, a projected 20 million new patients will enter the health care system over the next 18 months.
With the demand for care set to spike in 2014, the opportunities for frontline care providers seem abundant. And though still in training, budding physicians should be cognizant of the impending care demand and its implications. Further, it is paramount that students and health care stakeholders share open dialogue about medical students’ unique role as valued assets to the evolving health care system.
For years, the health care workforce has struggled to meet the demands of patients; in some respect, this has been attributed to a disproportionate patient-to-provider ratio. According to the American Medical Association, trend data projects a workforce shortage of roughly 63,000 providers in 2015 (interestingly, this is when most second year medical students will be graduating).
Naturally, stakeholders (i.e. providers, chief executive officers, and board members at non-profit and for-profit hospitals) are engaged in dialogue to develop new models of resource management. Many have speculated that this dialogue will yield innovative strategies to incentivize primary care providers and supportive staff. However, the role of medical students has yet to be fully elucidated, and therein lies a tremendous opportunity.
The National Resident Matching Program recently reported that, for the 2013 cycle, about 26,400 medical students were offered positions in domestic residency programs; 45 percent of the positions offered were "primary care-oriented." (Note: this data describes both allopathic and osteopathic graduates, who have successfully matched in pediatrics, family medicine, and the aggregated internal medicine sub-specialties.)
Though the infusion of 2,400 more residents may seem miniscule, with the clock ticking and many more patients set to enter a health care system already struggling without enough providers, it is rather significant. Medical students are becoming a workforce repository tailored to the ACA; it’s as if a primary care space is being carved for wearers of short white jackets while their longer coats are still being measured. By virtue of that fact, medical students should be heavily involved in conversations about resource allocation.
What Should Medical Students expect?
Current medical students should be sensitive to open enrollment and consumer information campaigns (led by government officials, community organizations, and advocacy groups). If enrollment in health insurance plans in the first three months grows significantly, it is likely to create opportunities. Generally, medical students should anticipate that the increasing patient pool will drive residency programs, and in particular primary care residencies, to increase the number of available positions. Likewise, medical students should expect an increase in service corps positions to match the structured training of a primary care workforce; in fact, expansion of loan-repayment and scholarship awards for service has already been underwritten by the ACA (extending from 2011 to 2015).
Amidst the incentivization, it is important to keep perspective—the developing health care system is far from perfect, and will require the collaborative efforts of all stakeholders to achieve sustainability within the first five years of ACA implementation. In that vein, the greatest expectation, and in some regards the greatest privilege, that students should own is the opportunity to pioneer health reform. Greater responsibility will be placed in the hands of tomorrow’s primary care providers, who will reshape care delivery in America.