First, I'd like to point out all this "how can we talk medical students into going into primary care" only makes primary care look bad. Orthopedic surgeons don't worry about how to convince medical students to go into their specialty. And there is nothing wrong with primary care - primary care is extremely important for individuals and for society - and this sort of dialogue only serves to artificially cheapen the profession.
I'll say what doesn't work... trying to trick medical students into going into primary care by exposing them only to primary care in their first couple years of medical school, attempting to make medical students feel guilty about wanting to pursue something other than primary care, and attempting to limit medical student access to learning opportunities (early in their education) to different specialties. All these sorts of strategies will do is make medical students resentful and, WRONGLY I must point out, similarly resentful of primary care. A medical school that adopts these strategies inadvertently demonizes primary care. I won't mention by name any particular med schools that do this, but I know of at least one...
The simple fact of the matter is that there is a "primary care crisis" not because too many people are in subspecialties, but because there are simply too few physicians to keep up with demand, and this is felt first at the primary care level -- increase the number of primary care physicians, and a "subspecialist crisis" will surely ensue; moreover, politicians and politican-influenced mass media fool themsleves - and some of us - into thinking that increasing the ranks of primary care physicians will fix many of our healthcare problems, simply because it's cheaper (sad to say... primary care physicians should get paid a lot more for what they do).
More importantly, medical students, like other human beings (we are human beings with our own free wills, by the way... all philosophical debates about free will aside for now), are motivated by what motivates them. Yes, some of us may be motivated by money. But I dare say those people are stupid, or at least foolish. As much work as is put into medical school and residency, put that work into another profession and you'll likely be making more (yes, that holds true even before Obamacare). Personally, I am motivated by my intellectual curiosity on the human body and what can go wrong with it and, just as much, what can be done to fix it. There are certain parts of the body I am more interested in than others (though all are obviously fascinating), and some ways of fixing problems I find more compelling than others. Primary care, as important as it is, and as much respect as I have for primary care physicians (believe me, it is extensive), does not fulfill me in this department.
Frankly, part of what helped me come to this conclusion is that my medical school has provided ample opportunity (in the form of mandatory classes) to be exposed to primary care on a weekly basis, whereas exposure to subspecialty areas must be pursued on one's own. In all this time spent in the primary care course, one thing became abundantly clear: whenever something interesting (what in my personal opinion was interesting) happened, the patient was referred. I wanted more than anything to be on that side of the referral whenever this happened, and more so for some cases (ie, those involving the organ systems I find most interesting) than others.
I didn't do premed in college, so i had to take off some time - a year of my life - post graduation to fulfill those academic requirements. I also spent years post college doing other things, either working or doing volunteer work to ensure that I really wanted to go into medicine. I didn't give up those years of my life to go into primary care; I am not going through the stress, hazing, and occasional tedium of medical school to go into primary care; not because the talking heads tell me "that's where there is the most need," not because my medical school is trying to trick me into it by enhancing access to it on the one hand and limiting access to it on the other. I gave up those years to pursue something I would find emotionally, intellectually, and spiritually gratifying. For me, that simply is not primary care. For some others out there, it is.
I am who I am, and I'm sick of this monologue on how to convince medical students - people - to do something they may not want to do, or to get them to go into something they might regret later. Whether plastic surgery, cardiology, or primary care, we should ultimately be able to chose, and be given the tools during medical school to make a wise decision (that's partly what we're paying for, isn't it?) -- because that is what will make the most content, the most dedicated, and the most enthusiastic physicians, and which will therefore, in turn, ultimately make the best possible healthcare system.
In short, my sense is that there is no legitimate way to convince medical students into going into primary care. Either they are interested in the first place, and this interest should be nurtured, or they're not, and attempts to convince them will either be unsuccessful and breed resentment or, worse, trick them into a life they later regret. Further, increasing the number of primary care physicians will serve squat without an increase in physicians of all specialties. It's time to stop this one dimensional way of looking at healthcare; it is at best non-productive, in reality it is counterproductive, and along the way it hurts medical students -- ie, future doctors.
ROFL
