OU-HCOM fills primary care gap in Ohio

Despite lower pay, our alumni continue to choose family practice, internal medicine and pediatrics

Sept. 7, 2008

By Richard Heck

Several recent studies suggest that the practice of primary medical care is on the wane. But at OU-HCOM, graduates continue to choose primary care specialties — family medicine, pediatrics and internal medicine — in large numbers.

Of the 106 members of the Class of 2008, 49 percent (52 graduates) entered primary care residencies. Of those, 26 chose family medicine, or about 24.5 percent. Another 20 graduates went into internal medicine, and six entered pediatrics.

“We are one of a dwindling number of medical schools who maintain primary care as a high priority,” said Dean Jack Brose, D.O. “We draw a lot of outstanding students here because of our reputation for providing an excellent foundation in primary care.”

Established in 1975, OU-HCOM’s record of educating primary care physicians shows:

• Approximately 54 percent of the college’s 2,461 total graduates serve as primary care providers. Of those, 37 percent practice in family medicine, and 16 percent are currently either in internal medicine or pediatrics.

• Of all OU-HCOM graduates, 62 percent remain in Ohio to practice medicine, while 46 percent serve in communities across the nation with a population of less than 50,000.

• About 11 percent of all OU-HCOM graduates practice in Appalachian Ohio.

All of those figures reflect the college’s mission, mandated by the Ohio General Assembly: to serve the health needs of people within the Appalachian region and other underserved populations, and to encourage the practice of family medicine.

Nationally, however, the numbers are quite different. Two studies published in the Sept. 10 edition of the Journal of the American Medical Association (JAMA) revealed that fewer U.S. medical students choose careers in primary care and primary internal medicine, citing salary as a key factor.

In one of the studies, of nearly 1,200 fourth-year medical students surveyed, just two percent planned to work in internal medicine. In a similar survey in 1990, the figure was nine percent. In contrast, more than 18 percent of OU-HCOM’s Class of 2008 entered internal medicine residencies.

The need for family physicians is expected to skyrocket by the year 2020, when the nation will need more than 139,000 family physicians, as estimated by the American Academy of Family Physicians.

“It is clear that as our society ages, the current shortage of primary care physicians is about to get much worse,” Brose said.

In a second recent JAMA report, Dr. Mark Ebell, a professor and assistant to the provost at the University of Georgia, compared 2007 average starting salaries for various medical specialties to the percentage of medical school graduates choosing those specialties.

Ebell found that primary care specialties have the lowest average starting salary, while some specialized medical fields, such as radiology and orthopedic surgery, offer average starting salaries higher than $400,000. He found a strong, direct correlation between the salary and popularity of a specialty, based on students' residency choices.

Because the medical students are graduating with increasingly high student debt, they choose specialties that pay significantly more than primary care fields, Ebell found.

The results echoed a similar study Ebell conducted 20 years ago, although the salary disparities have since grown. During the past decade, the number of U.S. medical school graduates entering family practice dropped by 50 percent.

The situation in Ohio reflects this trend. Brose acknowledged that despite the strong numbers of OU-HCOM graduates who enter primary health care, fewer choose to do so now compared to 20 years ago. In 1989, for example, more than 59 percent of OU-HCOM graduates practiced family medicine.

“Students are worried about paying off these educational debts, many of which exceed the cost of a house mortgage,” Brose said. “Society must confront the disparity between specialty reimbursement and either increase payment to primary care physicians or subsidize their training.”

Sharon Zimmerman, M.P.A., director of medical development and executive director of alumni affairs, cited recent alumni surveys, which reveal the levels of medical student debt OU-HCOM graduates incurred during their medical education.

“We have seen not only an upward trend in the cost of medical education over the past decade, but also in related expenses such as books, housing and gas,” Zimmerman said. “From 1999 to 2008, the average debt of OU-HCOM graduates increased from $89,182 to $150,868 — an increase of $61,686 (about 69 percent).”

“OU-HCOM works directly with each of our medical students, advising them on how to incur the least-possible amount of student debt,” Zimmerman said.

Earlier this year, the Office of Student Affairs' financial literacy programs for medical students received one of OU-HCOM's four commendations during an accreditation evaluation by the American Osteopathic Association’s Commission on Osteopathic College Accreditation. The programs include one-on-one financial aid counseling, debt management presentations and seminars on managing credit, budgeting, investing and planning for retirement.