Sunday, July 14, 2024

NC trend: Med-school grads opt against primary care, rural options.

It’s proving as difficult as ever to turn graduates of North Carolina’s public and private medical schools into primary care doctors — and to convince the few who do to practice in the 55 counties labeled as rural.

Only 14% of the state’s 2018 cohort of med-school graduates were training or practicing primary care medicine in North Carolina five years later, the UNC Area Health Education Centers noted in its annual report for legislators in April. That’s 84 out of 597 physicians trained by the medical schools at UNC Chapel Hill, East Carolina, Duke, Wake Forest and Campbell universities.

That number isn’t improving much. Ten years after graduating, just 10% of the 2013 med-school cohort were practicing in primary care in North Carolina, the report says. That’s 45 out of 445.

Moreover, just 14 of the 2018 group, or 2.4%, and six from the 2013 group, or 1.3%, were working in the 55 N.C. rural counties. The state has 100 counties.

The data isn’t much different from what AHEC has reported for years. Most physicians graduate with significant debt, and working in primary care tends to be less lucrative than most medical specialties. Family medicine doctors, internists, and pediatricians tend to average $250,000 to $275,000 of annual compensation, while orthopedists, cardiologists and other specialists earn twice as much on average, according to various industry pay surveys.

“The current average debt of graduating medical students nationally is now about $200,000,” and many well-financed large health systems often provide better recruiting incentives and salaries, the AHEC report says.

Dr. Jesse Ehrenfeld, the president of the American Medical Association, last year called the physician shortage a “public
health crisis.”

From 12% to 17% of graduating cohorts between 2010 and 2017 were training or practicing in primary care in North Carolina five years after graduating, the report notes. Only 1% to 3% of N.C. medical school graduates were practicing primary care in rural N.C. five years after graduating, AHEC adds.

ECU’s Brody School of Medicine traditionally sends a larger share of its graduates into primary care and rural areas than its N.C. peers. Of the 2018 cohort, 16, or nearly a quarter of the class, are in primary care. That compares with 31 UNC graduates, or 18% of its class.  The Greenville program is smaller than UNC School of Medicine.

Of the private medical schools, Campbell has become a bigger factor in the field than Duke or Wake Forest. Twenty-six Campbell graduates were in primary care, versus six from Wake Forest and five from Duke.

None of the Wake Forest or Duke–trained physicians were working in rural counties. UNC and Campbell had five each in rural counties, and ECU had four.

“Primary care physicians are the cornerstone of the state’s healthcare safety net” says Steve Lawler, president and CEO of the N.C. Healthcare Association, which represents hospitals. “Communities with a strong primary care presence are healthier and have better access to care.  “North Carolina is blessed to have several outstanding medical schools, such as ECU and UNC, that focus on training primary care physicians.  It is wise to continue to invest in the programs that train and graduate students who stay in North Carolina.”

AHEC defines “primary care,” as family medicine, general internal medicine, general pediatric medicine, internal medicine-pediatrics, and obstetrics and gynecology.

Meanwhile, just 12 of the 597 N.C. graduates from 2018 went into psychiatry in the state. None are practicing in a rural county.

To address the situation, legislators and the UNC System are expanding East Carolina with a $265 million medical school building expected to start construction early next year. It is slated for completion in the fall of 2027, with ECU’s annual class size growing to as many as 120 students. It graduated 81 in 2019, according to AHEC.

Also, AHEC says it’s been talking to officials at UNC and ECU about a pilot program to recruit students from rural communities into medical school, making sure there’s a “community health service track” for them to follow. More residency opportunities in rural areas would also be needed, along with efforts to eliminate medical-school debt incurred by would-be rural doctors.

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