Christin Spatz, MD [1], Kara Romanowski [1], Tanja Adonizio, MD [1], and Michelle Schmude, EdD [1]
1- Geisinger Commonwealth School of Medicine
Correspondence should be addressed to Christin Spatz, MD at cspatz@som.geisinger.edu
ABSTRACT
Preventative medicine and primary care services are the foundations to building healthier communities. Unfortunately, the resources are often limited, and it is estimated that by 2032, the United States could face a shortage of up to 21,000 to 55,200 primary care physicians [1]. This number may be even larger as the impact of the Covid-19 pandemic has yet to be seen. This deficit of physicians is even more pronounced in rural areas where residents are almost five times as likely to live in a county with a physician shortage [2]. There are a multitude of factors that contribute to this decline in workforce, but one pressing issue is the impact of medical student specialty selection. According to AAMC, specialty content and personality fit are always ranked as top reasons for specialty selection, while debt ranks much lower [4]. Despite this, numerous medical schools have begun to offer full tuition or scholarships in the hope that a debt free education will encourage more students to select primary care. In this commentary, we discuss the Geisinger Abigail Scholars Program which is a program offering free medical education and a living stipend in exchange for a commitment to Geisinger employment in primary care fields upon residency completion. One of the scholars offers her unique perspective as to why she selected this program and how this initiative can reinvigorate primary care interest, while serving as a model for other medical schools.
Primary care is the foundation on which the health system is built. Despite its critical role in building and maintaining healthier communities, resources in primary care have often been limited and are anticipated to decline over time. It is estimated that by 2032, the United States could face a shortage of up to 21,000 to 55,200 primary care physicians [1]. This number may be even larger as the impact of the Covid-19 pandemic has yet to be seen. This deficit of physicians is even more pronounced in rural areas where residents are almost five times as likely to live in a county with a physician shortage [2].
Primary Care physician workforce reform has become a central topic to address the decline in resources. The Council of Academic Family Medicine has devised the four pillars for primary care workforce development: pipeline, process of medical education, practice transformation and payment reform [3]. The process of exploring specialty selection during medical education has become an area of interest and potential opportunity. According to AAMC, specialty content and personality fit are always ranked as top reasons for specialty selection, while debt ranks much lower [4]. Despite this, numerous medical schools have begun to offer full tuition or scholarships in the hope that a debt free education will encourage more students to select primary care.
To address the growing concerns about primary care shortages and the rising expense of medical education, the Geisinger Commonwealth School of Medicine (GCSOM) developed the Abigail Geisinger Scholars Program. Modeled after the Military Loan Repayment Program, the Scholars Program gives students the option to graduate debt free while also receiving a living stipend in exchange for future employment as a Geisinger physician in the fields of internal medicine, family medicine, medicine pediatrics or psychiatry. After launching in 2019, the program quickly grew in popularity and now enrolls 45 students per year [5]. This program is intended for students who have self-selected primary care fields prior to matriculation. To encourage interest in primary care for those who have not committed to the program, GCSOM invites all students to participate in some of the unique program features. Depending on program capacity for that year, a select number of students may be eligible to enter the program after admittance to medical school.
The Abigail Geisinger Scholars Program is unique among other full tuition medical programs in that it attempts to address the key areas identified in the Council of Academic Family Medicine’s pillar regarding pipeline as well as process of medical education [3]. Students are given exposure to strong mentors, efforts are made to respond to the hidden curriculum, integration with interdisciplinary professional education is emphasized and students are exposed to a diversity of sites with community clinicians. By using this framework, the Abigail Geisinger Scholars Program gives students an opportunity to foster continued interest in primary care while actively becoming integral parts of building healthier communities.
Students are required to participate in leadership seminar series throughout their medical school training, where they learn about the business of medicine, research and genetics, physician leadership and payment models. In addition, students are immersed in signature experiences unique to Geisinger that focus on building healthier communities. These innovative programs include: Primary Care Redesign, which utilizes team-based care, population identification, and risk stratification in conjunction with use of electronic medical records; Fresh Food Farmacy, which offers no-cost nutritious food to food-insecure patients with diabetes; Geisinger 65 Forward, which is a program specifically designed for those older than 65 to have longer appointments, social activities, and wellness classes; Geisinger at Home, which provides care in one’s home for those with challenging medical conditions; lastly, the MyCode Community Health Initiative which examines the DNA of volunteers to diagnose medical conditions and serve as research for potential treatments.
Another impactful feature of this program is exposure to strong role models in the field of primary care and specifically strong mentoring relationships. Students are assigned a faculty mentor at entry into the program and remain with their mentor through their residency training. In addition, the medical students are also given resident mentors to help foster interest in the field and serve as a resource. These mentors serve a critical role of addressing the hidden curriculum in medicine and specifically any biases against the field of primary care.
Kara Romanowski is a current third year GCSOM student and Abigail Scholar who grew up in the Geisinger geographic footprint. She describes her vision of medicine and primary care and why she chose to select the Abigail Geisinger Scholars Program.
“When I used to picture medicine, I imagined a busy physician running down the halls of a hospital barking orders, saving lives, and sending patients back out into the world feeling much better than when they came in. Frankly, I found this picture a little unsatisfying for myself. What I wanted from medicine was something more: connection. I wanted to put my faith in my patients and have them return the notion by putting their trust and faith in me. I wanted to watch them make progress over time. I wanted to know the million little things that helped craft their one big story, and if I was lucky, I would get to meet and care for the other members of that story as well.
These ideas and concepts are what drew me to primary care and, as noble as they are, they always left me worrying about what my financial situation might be upon leaving medical school. The cost of medical education continues to rise, and primary care physicians are among the lowest paid. While I would like to think my decision to join the Abigail Scholars Program was not influenced by the financial incentives, I do not know if that would have been the truth. What I have learned over the past 3 years is that the incentives to this program go well beyond financial. The program hosts numerous seminars working to educate its members on the business aspects of medicine, something we as medical students receive little to no formal training on. In addition, the program has another compelling focus: service. Whether it is service to our community or service to other members, the program is constantly finding ways for us to stay connected, support each other, and help those around us. One specific example is our involvement with the Walk with a Future Doc program. This program encourages us to engage with more members of our community in a way that provides long-term health benefits for everyone participating. Furthermore, we also have ample opportunities for mentorship. We can connect with residents and attendings within the fields of family medicine, internal medicine, internal medicine/pediatrics, and psychiatry whenever we need to help navigate our journey as primary care focused medical students.
While I may have joined this program capitalizing on an initial primary care interest and financial incentive, I remain in this program more passionate than ever about primary care. I feel secure in my decision and am excited to be committed to a field that plays such a critical role in overall patient and community health. I encourage other institutions to adapt this model to reinvigorate passion for primary care while tackling the financial hardships students face.”
Kara’s story is like many others we have heard whose commitment to primary care has only strengthened by participation in the Abigail Geisinger Scholars Program. This year marks the first graduating class of primary care students, and over the course of the next 10 years this program will potentially generate an additional 450 primary care physicians in the Geisinger Health System. While this may seem small compared to the thousands needed to replace the physician shortage, it is a first step in replenishing the much-needed primary care workforce. This program can potentially serve as a model for other medical schools to create similar programs, which can have a significant impact on the physician shortage particularly in rural and underserved areas. While providing a financial incentive may impact a student’s decision to select primary care, the unique features of this program are what continue to solidify that commitment. As we continue to face workforce shortages in the future especially in primary care, we must create unique opportunities beyond financial that engage students and resident trainees to feel connected within the communities they serve.
REFERENCES
New AAMC Report Confirms Growing Physician Shortage. Washington, D.C., AAMC, 2020. (Accessed September 2, 2021, at https://www.aamc.org/news-insights/press-releases/new-aamc-report-confirms-growing-physician-shortage)
Addressing the Nation’s Primary Care Shortage: Advanced Practice Clinicians and Innovative Care Delivery Models. United Health Group. 2018. (Accessed September 2, 2021, at https://www.unitedhealthgroup.com/content/dam/UHG/PDF/2018/UHG-Primary-Care-Report-2018.pdf)
PCC Primary Care Collaborative. 2013. (Accessed September 2, 2021, at https://www.pcpcc.org/resource/four-pillars-primary-care-physician-workforce-development)
Will free medical school lead to more primary care physicians? Washington, D.C.: AAMC, 2019. (Accessed September 2, 2021, at https://www.aamc.org/news-insights/will-free-medical-school-lead-more-primary-care-physicians)
Abigail Geisinger Scholars Program. Geisinger, 2021. (Accessed September 2, 2021, at https://www.geisinger.edu/education/admissions/financial-aid/scholars-program)