By Randi Sokol M.D., M.P.H., Alisha Dyer, D.O., and Charlene Hauser, M.D., M.P.H.
Likely if you are reading this article, you are aware of the impending shortage of primary care doctors our nation faces: The Patient Protection and Affordable Care Act (PPACA) will be adding approximately 32 million new patients to the system by 2014. For a country that already has a huge shortage of primary care physicians, this added patient load poses daunting primary care workforce shortage issues, with a shortfall of approximately 46,000 PCPs predicted by the year 2025. The Council on Graduate Medical Education (COGME) estimates that in order to provide adequate access and hence optimal outcomes for our nation of patients, 40-50% of our workforce will need to be primary care physicians. Yet our medical schools continue to produce more physicians interested in specialty care. So, as primary care doctors who deeply believe in the importance of our role, what can we do to garner a future of primary care physicians who make up the majority of the workforce and are leaders within our medical communities?
In Sacramento, California, Residents from UC-Davis and Sutter Family & Community Medicine Programs in coordination with the California Academy of Family Physicians (CAFP) put our heads together to accomplish this task, creating the “Future Faces of Family Medicine” (FFFM) program to inspire a class of high school students to pursue a career in Family Medicine.
FFFM was shaped by our own unique early exposures to family medicine and public health. Alisha Dyer, D.O., recalls how her experience in the Medical Pathways Program during high school shaped her desire to pursue a career in primary care. Then, after a wavering pathway that included joining the Army National Guard, Dr. Dyer’s passions for primary care were rekindled when she had the opportunity to work one-on-one with Winters, CA, family physician Carla Kakutani, M.D., for four weeks through CAFP’s Summer Family Medicine Preceptorship Program. Now a third-year family medicine resident at Sutter and President of CAFP’s Residency Council, Dr. Dyer strives to inspire a new class of family physicians.
“The Future Faces of Family Medicine program that my colleagues and I created is one way that I can give back; instilling in students an excitement for primary care will hopefully enable them to keep their eye on the ball despite the many uphill battles they may encounter. At the same time, FFFM ultimately strives to benefit patients by producing compassionate and dedicated family physicians coming from similar backgrounds as the patients they serve,” she said.
Similarly, Dr. Charlene Hauser, now a Chief Resident at UC-Davis Family Medicine Residency Program had a rocky pathway. After completing her Intern year of Surgery Residency, Dr. Hauser realized that “the patients I was operating on, weren’t getting ’better.’ A procedure to remove a diabetic foot, bypass clogged blood vessels, or remove a colon cancer was a mere temporizing measure in the progression of obesity and smoking-related disease. If I wanted to actually HELP these patients, I needed to put my efforts into preventing their poor lifestyles.” Thus, Dr. Hauser says, she “left surgery to the surgeons and converted to Family Medicine, where public health and prevention are the treatments of choice.” Dr. Hauser’s early exposure to public health, earning an M.P.H. while in medical school, fueled her desire to provide high school students with early exposure to preventive medicine.
FFFM was modeled after a California-based pipeline program, Decision Medicine, which is designed to increase the number of minority high school students who go on to be physicians. The focus of FFFM, however, would be specifically on primary care, integrated with, rather than separate from their established high school curriculum, and continued longitudinally so the students would have follow up and mentorship along the road to primary care.
We started by partnering with a local high school, where we recruited 20 highly motivated high school students through a simple application process. Our residency programs were highly supportive and offered built in curriculum time for residents to work with the high school students as part of the FFFM program.
Through a four month program, residents from Sutter and UC-Davis worked together to design a curriculum that exposes high school students to lively discussions, hands-on workshops, and patient care, while employing their leadership skills. A total of six 75-minute weekday sessions and two half-day weekend sessions were conducted. Sessions including such topics as “What is Primary Care?,” “Adolescent Health,” and a panel of Family Medicine residents, who shared their struggles and victories down the road towards medical careers.
Students had the chance to get their hands wet practicing medical skills in “The Physical Exam” and “OB Delivery” workshops and had the opportunity to explore a cadaver lab, practice patient care scenarios in a state-of-the-art simulation suite and become CPR-certified. They also shadowed pre-med students, medical students and residents at a local volunteer clinic serving a medically underserved population. And students honed their leadership skills as they prepared and taught a health topic to their ninth grade health class. Students had reading assignments and wrote reflection pieces along the way.
To ensure the program truly becomes longitudinal, graduates from the FFFM program were paired with local family physicians for mentorship, providing more opportunities to shadow in clinic and additional support as the students head down the long academic road to medicine. At the same time, volunteer mentors earn CME credits for their time — a true win-win for both mentor and student.
“When the students found out that they would meet their physician mentors at graduation and have the chance to work with them one-on-one over the next year, they were truly ecstatic, ” said Randi Sokol, M.D., M.P.H., who is now a third-year Family Medicine Resident at UC-Davis. “Making the mentorship component a key piece to this program makes it a much more longitudinal experience for the students, further steering them down the pipeline to primary care.”
Now, will the Future Faces of Family Medicine programs truly cause more students to go into primary care?
"For 20 of them to end up in primary care is very unlikely," Sokol said, "but if we could get even one student out of a class of 20 to end up that way, it would be excellent. “
Still, all of the students who participated this year were very enthusiastic about their experience and encouraged to pursue a medical career.
Jennille Fleming, who will be a senior at Sacramento High in the fall, said the program was beneficial to her and her classmates. "It's important for students to have one-on-one time with doctors who are already doing what we want to do. It really helped me get some perspective. I've always wanted to be a doctor. That's always been my dream."
And this dream must be supported and nurtured, which is why we invited all the students’ families to their graduation and re-emphasized the call to primary care with their families there. “I could see in their parents’ eyes light up. They ‘got’ what primary care was all about and were proud to support their children’s future in this direction,” Sokol said.
Already, we have started out planning next year and adding new components to improve the program based on feedback from this past year. We plan to add a ‘professionalism’ workshop and a ‘careers workshop’ to teach the students how to prepare for a future professional career.
We are also now working on a webinar series to expose residency programs across the state to this program and are developing an on-line tool that other programs can use as a template and then tweak it to the needs of their residency program(s) and communities.
We hope this model of collaboration across Family Medicine programs will serve to inspire other primary care residency programs to similarly unite and lead programs that amplify our future primary care workforce.
Randi Sokol, M.D., M.P.H., is a third-year resident at University of California Davis Family and Community Medicine Program. Alisha Dyer, D.O., is a third-year family medicine resident at Sutter and President of CAFP's Residency Council. Charlene Hauser, M.D., M.P.H., is a Chief Resident at University of California Davis Family Medicine Program.