Where have all the medical students gone?

No, Pete Seeger has not written the anthem for health reform circa 2009. (Although it's not a bad idea).

It's the headline of a blog post from Bob Doherty of the American College of Physicians, who spends a lot of time peering into the primary care equivalent of a crystal ball, trying to see if anyone's home. (We are mixing our metaphors here but at least it reflects the fragmented nature of our health care system).

Doherty, Senior Vice President of Governmental Affairs and Public Policy for the ACP, accompanied 100 med students and internal medicine residents at a recent ACP leadership day on Capitol Hill. Their goal was to help restore primary care to its rightful place in the American medical universe.

He knows that unless something changes, preferably as part of an overhaul of the whole health system to improve access to preventive care and to improve coordination of care, young doctors are not going to enter primary care in adequate numbers.

Doherty writes:

Right now, about one out of three doctors in the U.S. are in primary care specialties, compared to the 50/50 mix found in other countries with higher performing health care systems. This would be bad enough, but unless next year's graduating class (and the ones that follow) are given a reason to look more favorably on primary care, fewer than one in five physicians will be in primary care. We know this because only 17% of U.S medical school graduates in 2008 expressed a desire to go into primary care, an all time low. We also know from studies that without more primary care physicians, the American people will experience higher cost of care and lower quality.

Doherty believes that we can't place the blame on young doctors for shunning primary care; we created the system that thwarts them. "If we really believe that patients should have a personal physician who is trained in comprehensive and longitudinal care, then we would show this to our medical students. We would pay primary care doctors better, reduce the paperwork and hassles ...associated with primary care, pay off their debt, and expose them to the joys of primary care in their training."

The ACP earlier this month put out a white paper on the primary care workforce. Among the key points:

• Establish a permanent national commission on the health care workforce to plan and set targets for increasing primary care capacity to meet the present and anticipated US health care needs.
• Med school loan forgiveness and related incentives for doctors-in-training to go into primary care.
• Better Medicare payments for primary care—not necessarily at the expense of specialists.
• Growth of patient-centered medical homes and other innovations designed to improve prevention, wellness, and care coordination.

These aren't the only ideas out there for fixing primary care. (Ask any nurse practioner). But if we don't take action soon, Pete Seeger may revise his folk classic, "If I had a Hammer." After all, what good's a hammer if there's no one to test your reflexes with it?