Friday, July 29, 2011

...and mentorship

Harvard MSIV, Nate Favini, did an excellent commentary on Dr. Pauline Chen’s NY Times article entitiled, “The Hidden Cost of Medical Student Debt”. Mr. Favini aptly added lack of economic diversity and personal motivation as key elements that affect medstudents’ desire to pursue primary care, in addition to debt. Both articles made strong cases and I suggest we add another to the list of factors contributing to med student interest in primary care -- mentorship.

I, like the AJPH article Mr. Favini cited, have long had a deep commitment to the “overworked and underserved” choosing to lead countless health fairs and educate prisoners about HIV/AIDS and sexual health while in medical school.  I am also one of the 10 percent of medical students cited in Dr. Chen’s article, who come from incomes in the lowest 40th percentile. I see myself reflected in my patients and my desire to help them is almost a natural corollary to that fact.  In addition, I have no qualms with living comfortably on a primary care physician’s salary, debt and all. Throughout medical school however, whenever I mentioned my interest in primary care, I received well-known looks of disdain/confusion and was repeatedly advised to choose a “more interesting specialty” where I would “actually get to practice medicine.” Despite this, I still managed to pursue a career in primary care but it was often a difficult decision to make. I was hard-pressed to find mentors.
A mentor helps to nurture interest. This Journal of General Internal Medicine article cites Daniel Levinson's perceived responsibilities of the mentorship relationship as:
  • teaching
  • sponsoring
  • guidance
  • socialization to profession
  • counsel
  • moral support
  • realization of the dream
Attendings often master teaching and even socialization to the profession but it is often quite difficult for a medical student to find a role model who takes vested interest in guiding, counselling and providing support needed to realize THE dream. Primary care physicians may be too busy and too much in need of compensation to mentor. An article from Brown University states,

In the current health care system, primary care doctors are constantly under pressure to see as many patients as possible. Time spent as a preceptor, instead of with a patient, is lost revenue.

I propose that while a physician may see mentoring as personal revenue lost, s/he may not realize the significant gains it would have for primary care as a specialty. Time spent nurturing medical students’ interest in primary care can lead to increases in the number of students who pursue it in residency. Deep motivation (this time by physicians) to advance the field is needed. Through a grant, Brown University has found some motivation for its physicians and is now actively promoting primary care choices in its medical students. Perhaps other medical schools can do the same. Even, developing CME courses to teach the tenets of mentorship.

The government is making an effort to increase the number of primary care spots in residency through its Primary Care Residency Expansion Program. In order to fill these spots with residents who are truly dedicated to primary care, the encouragement must begin in medical school. For students who are like I was, mentorship may provide the extra push needed to pursue this fulfilling and rewarding career.

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