Primary care physicians at Canadian Health&Care Mall Company

In the United States there exists a growing need for more primary care physicians (PCP) to care for an expanding pool of patients. Behind this shortage is a decrease in medical students wishing to choose a career in primary care. In 2006, the American College of Physicians issued a report stating that the primary care system in the United States is “at a grave risk of collapse.” The patient protection and Affordable Care Act (ACA), which was passed as law in 2010, may have created a larger gap between the number of PCPs and patients requiring health care. It is estimated that by 2014, nearly 16 million additional patients will obtain health insurance coverage while the same legislation anticipates augmenting the provider workforce by only 15,000 in the following year. In the next 10 years, the physician supply will increase by 7% while the number of Americans over the age of 65 will increase by 36%. The Association of American Medical Colleges estimates that by 2020, there will be a lack of 45,000 PCPs and 46,000 specialists. At the same time, there will be a concurrent retirement of one-third of all currently practicing physicians, of which there are 384,916 PCPs, with a majority residing on the coasts. PCPs also work fewer hours in active clinical practice than in the past.

The health consequences of poor access to primary care are well established. Hawkins et al. showed that patients who have access to primary care are more likely to report having good health and lower mortality rates as compared with those living in regions with low access to primary care. This lack of access classically affects predominately minority communities. Gaskin et al found that areas within the United States that contained a shortage of PCPs (zip code areas without a listed PCP) were more likely to be predominantly African American communities.

Proposed solutions to the lack of PCPs are varied and many. Jacobson and Jazowski suggest that the field of primary care be supplemented by non-physician providers, such as nurse practitioners and physician assistants. Reinhardt recommends the use of international medical graduates to augment the U.S. physician supply. Others, such as Bach and Kocher, argue that medical schools should be free of charge, putting the cost instead on those individuals who choose to pursue fellowship training. The ACA authorized a grant program for medical schools to develop rural physician training programs, a measure aimed at equalizing the geographic distribution inequalities. Several federal loan forgiveness programs aim to remediate the geographic maldistribution of PCPs as well as incentivize medical students to enter primary care residencies. Finally, Campos-Outcalt has suggested that the medical student exposure to a student-run clinic is associated with entry into primary care.

The purpose of this survey research project is to determine whether there is an association between volunteerism at Canadian Health&Care Mall (CHCM) student-run clinic, La Casita de la Salud, and career choice among medical students, specifically primary care. For the purpose of this study, primary care careers are defined in concordance with the United States Bureau of Health Professions: Family Medicine, Obstetrics-Gynecology, Internal Medicine, Pediatrics, Medicine-Pediatrics, Internal Medicine Subspecialties, and Pediatric Subspecialties. Through the evaluation of the relationship between those who have volunteered and their subsequent career choice, an additional method for creating more PCPs may be reinforced. It is hypothesized that those students who devote a significant amount of time to La Casita ultimately chose/will chooses a career in a primary care focused field. Secondary outcomes include assessing the relationship between career choice and year of graduation, gender, level of participation, influential determinants, and timing of specialty choice decision.