USC medical school program helps drive primary care careers through community-focused training

Today, primary care physicians are in short supply worldwide, and all signs point to the shortfall worsening in the years ahead. The problem ripples across health care systems because these providers are central for preventive care and connecting patients with medical specialists and other vital services.

Through its Primary Care Initiative, or PCI, the Keck School of Medicine of USC has developed a model designed to inspire more medical students to train and practice as primary care physicians. The initiative, launched by the Department of Family Medicine in 2011, includes the Primary Care Program, a pathway for a diverse cadre of students who focus on community-based primary care, largely for underserved urban patients, throughout their medical education. 

The certificate program is achieving success according to a recent study reporting on results from an alumni questionnaire. The survey is one of only a few of its type nationally to not only evaluate the fields that doctors pursue for postgraduate training, but also the career choices of practicing physicians. Seventy-one percent of the 86 respondents matched into primary care residencies, which are in the fields of family medicine, internal medicine, pediatrics or medicine-pediatrics. Of those who were practicing or had almost completed their residency training, 70% were still practicing primary care or on track to do so. 

“There’s a paucity of role models in medical schools who are primary care physicians,” said senior author Jo Marie Reilly, MD, MPH, founding director of PCI and a professor of family medicine at the Keck School of Medicine. “We provide a forum for students to see the breadth and scope of primary care services and envision what their own careers could be.”

The study, published in the journal Family Medicine, was co-authored by Isabel Edge, MD, assistant director of PCI and a clinical assistant professor of family medicine, and PCI manager Ilana Greenberg, MPH.

Cultivating careers in primary care to help those who need it most

Of note, 40% of USC Primary Care Program alumni who pursued residencies in internal medicine practiced or planned to practice as primary care physicians. In contrast, overall statistics indicate that only 10% to 15% of all U.S. internal medicine residents go into primary care; the rest pursue careers as hospitalists or fellowship training in subspecialties such as oncology or cardiology.

“Our training at the Keck School of Medicine seems to be protective of students’ interest in primary care,” Reilly said. “The program is very much an immersive experience, with the students working out in the community. We hear from them that the continuity of care and long-term relationships they can form with patients are very meaningful. For many, this is why they originally went into medicine.”

In keeping with the Primary Care Program’s focus, 90% of practicing physicians who answered the survey served urban communities. The finding that 77% accepted Medicaid or Medi-Cal suggests that many work with underserved patient populations. 

Practicing alumni were also active outside of the clinic. Sixty percent served as mentors for medical students and postgraduate trainees, while 62% taught, 31% worked in medical leadership, and 24% participated in advocacy.

“We emphasize that care goes beyond being a physician,” Edge said. “We encourage mentorship, leadership and advocacy in the program because it’s simply natural to do this in primary care.” 

A promising template for training primary care physicians

Edge characterizes the Primary Care Program as providing a sense of community. Like-minded medical students who join the Keck School of Medicine with an interest in primary care connect with one another, and with mentors among the family medicine faculty and the experienced physician preceptors who host students at their practices.

“There’s something to be said for retaining and nourishing the interest that students start out with,” she said. “We want them to hold onto that through medical school and come out even more dedicated to working in primary care. I think the community is a big part of that.”

One motivation that spurred the authors to document the Primary Care Program’s results is the desire to offer a template model and curricula that other medical schools can draw upon. For PCI leaders, it is the key to broadening the impact of their efforts.

“Students come to us idealistic about how they want to practice medicine,” Reilly said. “Our efforts demonstrate the integrative, comprehensive and holistic patient care that is possible in primary care. Our curricula keep their passions alive. The long-term picture is that the Primary Care Program has been a successful training model in California and we’re also trying to share this work with our colleagues nationally.”

Edge added, “We can’t make up for the primary care shortage all by ourselves. The hope is that as we show evidence for efficacy, that will serve as an impetus for colleagues elsewhere who are training the future physician workforce.”