The AMSA Foundation’s Seventh Annual Primary Care Scorecard
The New Physician
The New Physician has published the American Medical Student Association (AMSA) Foundation’s “Primary Care Scorecard” for the past seven years. Each year, the scorecard has been fine-tuned to best meet the needs of premeds and medical students interested in primary care, but this year’s card is drastically different. Previously, the foundation ranked all U.S. allopathic and osteopathic medical schools according to each institution’s proportion of medical graduates entering primary care residency programs. Although this format seemed effective in the past, the foundation decided it was time to make the scorecard more “user friendly.”
This year’s card focuses on specific primary care residency areas—family medicine, internal medicine, pediatric and combined internal medicine/pediatric residencies—and lists the top 10 allopathic and top three osteopathic medical schools with the highest proportion of medical graduates entering each residency area.* (True scorecard aficionados and loyalists can spend their free time perusing the foundation’s traditional ranking of all the schools on the Web at www.amsa.org/programs/pcscore7.cfm.)
But before you flip to the scorecard, let’s take a closer look at primary care medicine and how premeds and medical students interested in this field can better ensure they will receive the proper education and training.
WHAT IS PRIMARY CARE?
According to the American Academy of Family Physicians, “Primary care is that care provided by physicians specifically trained for and skilled in comprehensive first contact and continuing care for persons with any undiagnosed sign, symptom, or health concern…. [It] includes health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses in a variety of health care settings…. Primary care is performed and managed by a personal physician often collaborating with other health professionals, and utilizing consultation or referral as appropriate.”
WHY FOCUS ON PRIMARY CARE?
Nearly every medical school exposes medical students to the glitz and glamour of the most current interventional technology used by specialists. But many schools do not adequately expose students to the rewards of primary care medicine. This is a great disservice not only to medical students who will make career decisions based on limited experiences, but also to our health-care system, which suffers a shortage of primary care physicians.
The decision to go into primary care medicine should be based on one’s interests and experiences. The scorecard is designed to raise awareness of primary care medicine as a career option and to help students think about the steps they may want to take in order to give primary care a fair consideration as a potential career.
WHO SHOULD USE THIS SCORECARD AND HOW
Premeds can use the scorecard to determine which schools foster primary care ideals. Medical students can use the information to assess programs at other schools and to help initiate curriculum reform at their institutions. That being said, this scorecard should not be interpreted as an assessment of a particular medical school. And if your earliest childhood memory is the day you decided you wanted to be a cardiothoracic transplant surgeon, then the scorecard may not help you with future career decisions.
Essential questions for premeds:
A medical school’s curriculum and focus can have a profound impact on the type of residencies and careers pursued by its graduates. So premeds, if you are interested in primary care, keep the following questions in mind when interviewing at a medical school.
What are the core third-year required rotations? More specifically, is there a family medicine rotation?
Many medical graduates who enter primary care residencies say their family medicine rotations heavily influenced their career decisions. Not all medical schools offer a family medicine third-year rotation. So if you’re considering this field, be sure to ask your interviewers about the institution’s third-year family medicine learning opportunities. The timing of the rotation is crucial, because most students have to make specialty and residency decisions early in their fourth year. Would you feel comfortable committing to a field of medicine that you have not experienced? Probably not. This is why schools that lack a third-year family medicine rotation do not have a high family medicine residency match rate.
DOES THE SCHOOL HAVE A FAMILY MEDICINE DEPARTMENT?
If the institution lacks a family medicine department, you may find it offers students a limited primary care experience.
How many full-time faculty members are primary care physicians?
You need to be sure there are sufficient mentors, ambulatory rotations and adjunct faculty available to help guide you through your education and to show you the diverse set of primary care career options.
Where and what do the majority of its graduates practice after residency?
Many schools do not collect this type of data, but those that do can give you a fair assessment of the types of students the school attracts and the types of physicians it produces. This will help you determine if the institution is the right match for you.
In general, does the school have an institutional commitment to primary care?
An institution with a strong commitment will have primary care opportunities woven throughout its curriculum. For example, find out if the school offers a continuity clinic where students can follow a group of patients over an extended period of time. Also, you may want to determine whether students are offered the opportunity to have a primary care-centered mentor or adviser.
Action items for medical students:
Medical students interested in primary care should check to see what opportunities their schools offer. And once you do this, ask yourself:
Do the opportunities reflect the interests of my class?
If not, get involved with curriculum committees and other administrative bodies to ensure that future students are exposed to primary care medicine. Discuss such ideas as establishing continuity clinics, expanding the number of ambulatory rotations, creating better mentor networks and giving all students an early exposure to primary care medicine.
It often takes several years for curriculum changes to be instituted—so, in the meantime, you should create a more comprehensive primary care experience for yourself. For example, you can arrange for primary care electives early in your training. Talk to fourth-years who plan to match in primary care residencies and ask them about the good sites for elective rotations.
GET INVOLVED WITH NATIONAL PRIMARY CARE WEEK.
The AMSA Foundation’s National Primary Care Week (NPCW) is a student-led, interdisciplinary effort to expose students to primary care. More than 120 schools participate in this program. This year’s NPCW will be held Oct. 20–26. The theme will be “Access: Bringing Health Care to Communities.” Get involved with NPCW and help plan events to raise awareness of primary care medicine at your school.
Simon Ahtaridis is a fourth-year medical student at Temple University. Laura Hoeksema, an AMSA intern, also contributed to this scorecard.