Medical schools, primary care and family medicine: clerkship directors’ perceptions of the current environment

2019 ◽  
Vol 36 (6) ◽  
pp. 680-684
Author(s):  
Maribeth Porter ◽  
Denny Fe Agana ◽  
Robert Hatch ◽  
Susmita Datta ◽  
Peter J Carek
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Medical School ◽  
School Environment ◽  
Student Attitudes ◽  
Primary Care Physicians ◽  
Specialty Choice ◽  
Medicine Clerkship ◽  
Negative Comments ◽  
The Usa

Abstract Background The culture at a medical school and the positive experiences in primary care clerkships influence student specialty choice. This choice is significant if the demand for primary care physicians is to be met. The aim of this study was to examine family medicine clerkship directors’ perceptions of the medical school environment. Methods Data were collected as part of the 2015 Council of Academic Family Medicine Educational Research Alliance Family Medicine Clerkship Director survey. Questions asked included how clerkship directors perceived the environment of their medical school towards family medicine, has the environment towards family medicine changed between 2010 and 2015, do they take action to influence student attitudes towards family medicine and whether faculty members in other departments make negative comments about family medicine. Results The response rate was 79.4%. While most respondents indicated the environment of their medical school has become more positive towards family medicine, a majority of clerkship directors perceived the environment to be either very much against, slightly against or indifferent towards family medicine. Nearly one-half (41.4%) of the clerkship directors were notified more than once a year that a faculty member of another department made a negative comment about family medicine. Results varied among regions of the USA and between schools located in the USA and Canada. Conclusion Family medicine clerkship directors often perceived negativity towards family medicine, a finding that may limit the effectiveness of academic health centres in their mission to better serve their community and profession.

scholarly journals Institutional NIH Research Funding and a Culture of Support for Family Medicine—Their Relationship to Family Medicine Specialty Choice

2018 ◽  
Vol 50 (5) ◽  
pp. 369-371
Author(s):  
Arch G. Mainous ◽  
Maribeth Porter ◽  
Denny Fe Agana ◽  
Alexander W. Chessman
Keyword(s):  
Medical Students ◽  
Family Medicine ◽  
Medical School ◽  
School Environment ◽  
The United States ◽  
Specialty Choice ◽  
Medicine Clerkship ◽  
Educational Support ◽  
Negative Comments ◽  
Nih Funding

Background and Objectives: The United States suffers from a low proportion of medical students pursuing family medicine (FM). Our objective was to examine institutional characteristics consistent with a focus on National Institutes of Health (NIH) research, institutional support for FM education, and the proportion of medical students choosing FM. Methods: The 2015 CERA Survey of Family Medicine Clerkship Directors was merged with institutional NIH funding data from 2014 and medical student specialty choice in 2015. Institutional educational support was operationalized as (1) clerkship director’s perception of medical school environment toward FM, and (2) amount of negative comments about FM made by faculty in other departments. The outcome was the percentage of students selecting FM. Bivariate statistics were computed. Results: As NIH funding increases, the proportion of students entering FM decreases (r=-.22). Institutions with higher NIH funding had lower clerkship director perceptions of medical school support toward FM (r=-.38). Among private institutions, the negative correlation between NIH funding and the proportion of students entering FM strengthens to r=-.48, P=.001. As perceptions of support for FM increase, the proportion of students entering FM increase (r=.47). Among private schools, perceptions of support toward family medicine was strongly positively correlated with the proportion of students entering FM (r=.72, P=.001). Conclusions: Higher institutional NIH funding is associated with less support for FM and lower proportions of students choosing FM. These issues appear to be even more influential in private medical schools. Understanding how to integrate the goals of NIH-level research and increasing primary care workforce so that both can be achieved is the next challenge.

scholarly journals Primary Care Tracks in Medical Schools

PRiMER ◽  
2019 ◽  
Vol 3 ◽  
Author(s):  
Maribeth P. Williams ◽  
Denny Fe Agana ◽  
Benjamin J. Rooks ◽  
Grant Harrell ◽  
Rosemary A. Klassen ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Students ◽  
Family Medicine ◽  
Primary Care Physicians ◽  
Response Rate ◽  
Positive Impact ◽  
Medical Schools ◽  
Clerkship Director ◽  
Medicine Clerkship ◽  
Faculty Mentorship

Introduction: With the estimated future shortage of primary care physicians there is a need to recruit more medical students into family medicine. Longitudinal programs or primary care tracks in medical schools have been shown to successfully recruit students into primary care. The aim of this study was to examine the characteristics of primary care tracks in departments of family medicine.  Methods: Data were collected as part of the 2016 CERA Family Medicine Clerkship Director Survey. The survey included questions regarding the presence and description of available primary care tracks as well as the clerkship director’s perception of impact. The survey was distributed via email to 125 US and 16 Canadian family medicine clerkship directors.  Results: The response rate was 86%. Thirty-five respondents (29%) reported offering a longitudinal primary care track. The majority of tracks select students on a competitive basis, are directed by family medicine educators, and include a wide variety of activities. Longitudinal experience in primary care ambulatory settings and primary care faculty mentorship were the most common activities. Almost 70% of clerkship directors believe there is a positive impact on students entering primary care.  Conclusions: The current tracks are diverse in what they offer and could be tailored to the missions of individual medical schools. The majority of clerkship directors reported that they do have a positive impact on students entering primary care.

scholarly journals Factors Affecting Specialty Choice Among Doctors Who Received Tuition Scholarships

2019 ◽  
Vol 51 (3) ◽  
pp. 276-281 ◽  
Author(s):  
Bich-May Nguyen ◽  
Gregory Bounds
Keyword(s):  
Primary Care ◽  
Medical School ◽  
Primary Care Physicians ◽  
Online Survey ◽  
The United States ◽  
Specialty Choice ◽  
Factors Affecting ◽  
Educational Debt ◽  
Medical School Graduation ◽  
School Graduation

Background and Objectives: The United States is projected to have a shortage of up to 46,000 primary care physicians by 2025. In many cases, medical students appear to select other specialties for financial reasons, including educational debt. Physicians who were part of two BS/MD programs and received full tuition and fee scholarships for college and medical school were surveyed to examine factors that may have impacted their specialty choice. This population of US students was selected because they do not have educational debt, so their choices could be examined independent of this influence. Methods: One hundred forty physicians who graduated from the programs as of June 2013 were invited to complete a 32-question online survey. Descriptive statistics described the population. χ2 tests and nonparametric Wilcoxon rank-sum (Mann-Whitney) tests compared primary care and nonprimary care physicians as well as those initially interested in primary care who changed before medical school graduation versus those who went into primary care. Factor analysis and Student t-test examined trends among Likert scale questions. Results: For the physicians for whom contact information was available, 74 (53%) responded. Out of 74 respondents, 18 (24%) went into primary care. Perceptions of family medicine, comments from faculty, and lifestyle played a role in deterring students from primary care. Conclusions: Full tuition and fee scholarships alone were not associated with more students choosing primary care.

scholarly journals Graduating Medical Student Perspectives on Factors Influencing Specialty Choice

2019 ◽  
Vol 51 (2) ◽  
pp. 129-136 ◽  
Author(s):  
Amanda Kost ◽  
Ashley Bentley ◽  
Julie Phillips ◽  
Christina Kelly ◽  
Jacob Prunuske ◽  
...  
Keyword(s):  
Family Medicine ◽  
Medical School ◽  
Student Perceptions ◽  
Student Attitudes ◽  
Specialty Choice ◽  
Perceptions And Attitudes ◽  
Rank List ◽  
Mentor Attributes ◽  
National Programs ◽  
Selection Of

Background and Objectives: Fewer than 10% of US medical school graduates enter family medicine residencies each year. Little is known about the perceptions and attitudes of senior medical students as they make final decisions about specialty choice, especially those that support a decision to pursue family medicine. The American Academy of Family Physicians (AAFP) administered a national survey to US seniors in 2015 to explore these factors. Methods: US seniors who were AAFP members (N=11,998) were invited to complete a survey exploring attitudes toward family medicine and experiences that influenced interest and choice of family medicine (FM) or other specialties. This was offered after students submitted their National Residency Matching Program rank list but before match. For those matching in family medicine, additional questions explored mentorship experience. Factors significantly predicting intent to match in family medicine, mentor attributes significantly influencing student attitudes, and family medicine interest group (FMIG) participation were identified via regression. Results: The survey response rate was 15.1%. Student perceptions of the respect of FM (OR=0.82), the future of FM (OR=2.04), and FMIG involvement (OR=1.75) predicted choosing FM, as did AAFP student membership (OR=2.13-2.44) and AAFP National Conference of Family Medicine Residents and Students attendance (OR=9.77). For students entering FM, having supportive mentors outside of FM and being dedicated to FM positively influenced their attitudes toward FM and their FMIG participation. Conclusion: National programs, FMIGs, mentorship, and medical school support of family medicine play a role in student selection of family medicine.

scholarly journals The Effect of Teaching Family Medicine Clerkship Students on Preceptor Productivity

PRiMER ◽  
2020 ◽  
Vol 4 ◽  
Author(s):  
Tomoko Sairenji ◽  
Samuel Griffin ◽  
Misbah Keen
Keyword(s):  
Primary Care ◽  
Medical Student ◽  
Family Medicine ◽  
Student Teaching ◽  
Primary Care Physicians ◽  
Clinical Teaching ◽  
Medical Student Education ◽  
Billing Data ◽  
Medicine Clerkship ◽  
Number Of Patients

Introduction: High-quality, experiential learning in outpatient settings is indispensable for medical student education; however these settings are difficult to recruit and retain. The majority of primary care physicians are employed by organizations and are under pressure to increase their relative value unit (RVU) production. Although the common perception that teaching medical students decreases productivity is unproven, it is likely a barrier for primary care physicians pursuing clinical teaching. We sought to investigate whether medical student teaching affects clinical productivity. Methods: We recruited 15 family medicine (FM) clerkship sites to participate in our study via email and at an in-person meeting. For each preceptor, we collected billing data in the form of current procedural terminology (CPT) codes for all patient encounters and the number of patients seen per half-day for when the preceptor had a student and when they did not. We converted CPT codes to RVU data. We compared differences in productivity for each individual preceptor, and we used a paired t test to examine collective data with and without a student. Results: Ten preceptors at six FM clerkship sites provided reliable data. The average RVU per half-day without a student was 10.84, and it was slightly higher at 11.25 when a student was present (P=.74). The average number of patients seen per half-day without a student was 8.32 and it was slightly lower at 7.87 when a student was present (P=.58). Conclusion: This study shows promising data that teaching students in the outpatient setting does not decrease preceptor productivity. This pilot study can lead to a larger-scale exploration of family medicine preceptor productivity in different settings and institutions.

scholarly journals Responses of physicians to an objective safety and quality knowledge test: a cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e040779
Author(s):  
Harry B Burke ◽  
Heidi B King
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Cross Sectional Study ◽  
Choice Test ◽  
Quality And Safety ◽  
Cross Sectional ◽  
Percent Correct ◽  
Quality Perceptions ◽  
Clinical Vignettes ◽  
The Usa

ObjectiveFor physicians to practice safe high quality medicine they must have sufficient safety and quality knowledge. Although a great deal is known about the safety and quality perceptions, attitudes and beliefs of physicians, little is known about their safety and quality knowledge. This study tested the objective safety and quality knowledge of practicing US primary care physicians.DesignCross-sectional objective test of safety and quality knowledge.SettingPrimary care physicians practicing in the USA.ParticipantsStudy consisted of 518 US practicing primary care physicians who answered an email invitation. Fifty-four percent were family medicine and 46% were internal medicine physicians.The response rate was 66%.InterventionThe physicians took a 24-question multiple-choice test over the internet.OutcomeThe outcome was the percent correct.ResultsThe average number of correct answers was 11.4 (SD, 2.69), 48% correct. Three common clinical vignettes questions were answered correctly by 45% of the physicians. Five common radiation exposures questions were answered correctly by 40% of the physicians. Seven common healthcare quality and safety questions were answered correctly by 43% of the physicians. Seven Donabedian’s model of structure, process and outcome measure questions were answered correctly by 67% of the physicians. Two Institute of Medicine’s definitions of quality and safety questions were answered correctly by 19.5% of the physicians.ConclusionForty-eight per cent of the physicians’ answers to the objective safety and quality questions were correct. To our knowledge, this is the first assessment of the objective safety and quality knowledge of practicing US primary care physicians.

Billing Codes Determine Lower Physician Income for Primary Care and Non-Procedural Specialties

2019 ◽  
Vol 22 (2) ◽  
Author(s):  
Arielle L. Langer ◽  
Miriam Laugesen
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Primary Care Physicians ◽  
Direct Consequence ◽  
Medical Specialties ◽  
Income Differences ◽  
Income Gap ◽  
Physician Income ◽  
The Difference ◽  
The Relationship

Abstract The income gap between specialists and primary care physicians and among specialists is well established, but the drivers of this difference are not well delineated. Using the Community Tracking Study (CTS) Physician Survey, we sought to isolate and compare premiums paid to physicians for specialization and the proportion of time spent on offices visit rather than procedures. We divided medical subspecialties according the proportion of Medicare billing for Evaluation and Management (E&M) codes for the specialty as a whole. We report substantial differences in income across physician specialty, and over 70 percent of the difference in income remained controlling for factors that may confound the relationship between income and specialty including gender, location and type of practice, and hours. We note a large variation in premiums for specialization: 11.3–46.8 percent above family medicine after controlling for confounders. Classifying medical subspecialties by E&M billing as procedural versus non-procedural specialties revealed clear income differences. Controlling for confounders, procedural medical specialties earned 37.5 percent more than family medicine, as compared with 15.3 percent for non-procedural medical specialties. This analysis suggests that differences in physician income and resulting incentives are a direct consequence of the payment structure itself, rather than compensation for additional years of training or a reflection of different underlying demographics.

scholarly journals The Role of Obesity Training in Medical School and Residency on Bariatric Surgery Knowledge in Primary Care Physicians

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Fatima Cody Stanford ◽  
Erica D. Johnson ◽  
Mechelle D. Claridy ◽  
Rebecca L. Earle ◽  
Lee M. Kaplan
Keyword(s):  
Bariatric Surgery ◽  
Primary Care ◽  
Medical School ◽  
Primary Care Physicians ◽  
Massachusetts General Hospital ◽  
Treatment Strategies ◽  
Treatment Modalities ◽  
Survey Respondent ◽  
Healthy Weight ◽  
Cross Sectional

Objective. US primary care physicians are inadequately educated on how to provide obesity treatment. We sought to assess physician training in obesity and to characterize the perceptions, beliefs, knowledge, and treatment patterns of primary care physicians. Methods. We administered a cross-sectional web-based survey from July to October 2014 to adult primary care physicians in practices affiliated with the Massachusetts General Hospital (MGH). We evaluated survey respondent demographics, personal health habits, obesity training, knowledge of bariatric surgery care, perceptions, attitudes, and beliefs regarding the etiology of obesity and treatment strategies. Results. Younger primary care physicians (age 20–39) were more likely to have received some obesity training than those aged 40–49 (OR: 0.08, 95% CI: 0.008–0.822) or those 50+ (OR: 0.03, 95% CI: 0.004–0.321). Physicians who were young, had obesity, or received obesity education in medical school or postgraduate training were more likely to answer bariatric surgery knowledge questions correctly. Conclusions. There is a need for educational programs to improve physician knowledge and competency in treating patients with obesity. Obesity is a complex chronic disease, and it is important for clinicians to be equipped with the knowledge of the multiple treatment modalities that may be considered to help their patients achieve a healthy weight.

scholarly journals The Role of Primary Care Physicians (DLP) in Community Care

2018 ◽  
Vol 1 (1) ◽  
pp. 3
Author(s):  
Dhanasari Vidiawati Trisna Sanyoto ◽  
Nur Afrainin Syah
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Primary Care Physicians ◽  
Medical Training ◽  
The United States ◽  
Care Physician ◽  
Main Body ◽  
Family Doctors ◽  
Postgraduate Medical Training ◽  
Care Services

Dokter Layanan Primer (DLP) or Primary Care Physician (PCP) is a newly introduced term by the Indonesian government in 2013 since the enforcement of Medical Education Law 20/2013. DLP is a physician who solidifies his/ her education and career in primary care. They have postgraduate medical training in primary care and are experts in this field. In most countries, to be a generalist physician practising at primary care facilities such as health centres and primary care clinics, medical school graduates have to take postgraduate medical training to be proficient in terms of knowledge and skills in primary care services. Family medicine is the main body of knowledge of the primary care postgraduate training program in those countries even though their graduates are called differently among countries. These physicians are called family doctors or family physicians in the United States of America (USA), general practitioners (GPs) in Commonwealth countries, huisarts in the Netherlands. In Indonesia, where social, economic, and cultural diversity is very high in various regions, in addition to Family Medicine, Community Medicine and Public Health....

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