A growing population, an aging population (physicians included) and the entrance of newly insured individuals following implementation of the Affordable Care Act, have increased the demand for medical services across the country. To add to this, the physician to patient ratio is not evenly distributed across all population areas or groups, making for an increasingly precarious situation. America is facing a shortage of primary care physicians, and the situation is even worse in Texas.
According to the Association for American Medical Colleges (AAMC) the nation will face a shortage of between 46,000-90,000 physicians by 2025. In Texas, 126 of 254 counties experience limited access to primary care services, a large enough deficit for the U.S. Department of Health and Human Services to declare these regions Health Professional Shortage Areas. Texas has 165 physicians for every 100,000 patients – which is below the national average.
The Texas A&M Health Science Center College of Medicine is working to change this trajectory and answer the call for more primary care physicians across the state
An expanding program: In both size and scope
Since 2007, the college has increased its enrollment from 300 M.D. students to 800, and added three additional campuses in Dallas, Houston and Corpus Christi to their already established education centers in Bryan-College Station, Temple and Round Rock. Today, the college utilizes approximately 2,600 basic and clinical science faculty in instructional programs and partners with some of the state and nation’s top hospitals.
Medical students are offered a wide range of clinical experiences enabling each student to identify his or her career focus or specialty area in medicine. All locations have primary care physician faculty to serve as role models. In these various settings, the clinical training program extends into hospitals, managed care organizations, private clinics and other outpatient settings.
In addition to producing more graduates, Texas A&M College of Medicine alumni tend to stay in Texas for residency programs and later as practicing physicians, helping to address the shortage both now and in the future. In fact, 64 percent of graduates choose residencies in Texas, with 50 percent entering primary care practice. This makes Texas A&M a leader in producing primary care physicians, both in Texas and nationally.
So how is Texas A&M producing such high numbers of primary care physicians? It all starts with the recruitment process.
While the college does not formally recruit a certain number or percentage of students declared for primary care practice, the college’s Interim Dean, Paul Ogden, M.D., F.A.A.C.P, says he believes that the type of students recruited see the value in fulfilling this need in health care and are inspired to answer the call.
“We pride ourselves on our sense of service, it is the Aggie way,” Ogden said. “I believe our students see the need for primary care and see how our faculty make an enormous impact through primary care, so many make the choice to follow this path. We recruit to find physicians who want to affect change and make a difference – not only in each of their patients’ lives, but across populations.”
Ogden, a primary care physician himself, explained that primary care physicians offer the treatments and preventive screenings that save lives and head off expensive emergency room visits and hospitalizations. This not only saves lives and increases quality of life, but reduces health care costs for individuals and the health care system as a whole.
Learning outside the classroom: Programs that encourage primary care
Additionally, the Texas A&M College of Medicine participates in several statewide pipeline programs to recruit future physicians to serve in rural and minority communities. The Partnership for Primary Care (PPC) is one of these programs and serves as an alternative path to medical school. The PPC program recruits high school and college students from rural, medically underserved, primary care or health professional shortage areas (as defined by the U. S. Department of Health and Human Services Health Resources and Services Administration).
Texas A&M not only recruits students with a sense of service, but they also cultivate that value in these future physicians. In addition to a faculty that positively represents a career in primary care practice, students are increasingly exposed to populations that can benefit most from primary care treatment.
Several volunteer clinics across the college’s campuses expose students to indigent populations in the very communities students reside. Martha’s Clinic in Temple, which just celebrated its 20th year of service, was created by a few Aggie medical students who were volunteering at a homeless shelter, taking blood pressure levels of patients with no access to routine clinical care. The clinic now offers free primary care services and screenings to those who need it most, and is fully run by the college’s fourth-year medical students.
“These clinics also highlight the importance of primary care,” Ogden said. “The benefits of primary care are most evident in these populations. In many cases within these clinics, regular primary care maintenance, screenings and services could have drastically improved the outcomes of these patients – and our students are seeing that first-hand.”
Also, the college has significantly increased its involvement with mission trips across the world. Two of the most popular are trips to Haiti and Ecuador. The college has partnered with LiveBeyond to bring health care to Haitians who have no other access to health care.
“These experiences show students the value of primary care in under-represented populations in ways a classroom setting cannot,” Ogden said. “They can see the immediate need for primary care, particularly for the treatment of chronic diseases.”
Primary care: Imperative for the most expensive and widespread diseases affecting health care
While the sheer numerical need for primary care physicians is staggering, the situation becomes even more dire when you consider that back in 2012, the CDC reported that about half of all adults – about 117 million people – had one or more chronic health conditions. The growing prevalence of chronic diseases, the most costly and preventable of all health problems, makes primary care physicians the front-line defense for the majority of American patients.
Diabetes, hypertension, heart disease, obesity, arthritis, stroke and cancer are the leading chronic diseases in the United States. They are also reasons why a primary care-based delivery system increases quality of care and decreases costs when compared to the current specialist-based delivery system.
Ogden explained that Texas A&M is doing its part to improve the health care system through both education and institutional changes.
Texas A&M students aren’t just medically trained, they are becoming the leaders of health care. With joint programs across the Texas A&M University, students are broadening their perspectives with Masters in Business Administration degrees from the Mays Business School and graduate certificates from the Bush School of Government and Public Service.
The college has even proposed a research, innovation and policy institute dedicated to transforming health care delivery and improving outcomes. The institute will focus on primary care, promote and incentivize wellness, leverage systems, teams, information technology and devices to increase the effectiveness and scope of physicians.
The recently announced the addition of the MatureWell Center, a two-story, 23,000-square-foot complex, will serve as a platform to expand health care research and education for mature populations.
“MatureWell will help educate future primary care physicians, help us expand translational research of mature population care and help inform the proposed institute and the state on the most effective health care strategies for one of our most quickly expanding and costly patient populations,” Ogden said.
The primary care shortage is a comprehensive issue that requires a comprehensive approach that reaches all aspects of the health care system. Because training a doctor takes between five and 10 years, acting now can help alleviate the projected shortage in 2025.
“The solution requires a multi-pronged methodology and Texas A&M is dedicated to providing both more—and better—educated primary care physicians than ever before, starting with the hearts and minds of our students,” Ogden said.