ROANOKE TIMES
Copyright (c) 1996, Roanoke Times
DATE: Monday, September 23, 1996 TAG: 9609230100
SECTION: VIRGINIA PAGE: C-1 EDITION: METRO
DATELINE: NORFOLK
SOURCE: MARIE JOYCE LANDMARK NEWS SERVICE
Ryan Cooley stands in the lobby of Lewis Hall at a reception for first-year students. He wears a crisp Eastern Virginia Medical School T-shirt.
Members of the class of 2000 are just starting their medical education, and Cooley is pondering his options. He doesn't think he'll be a specialist. He's going to be some type of general practitioner, like a pediatrician.
Maybe.
``I want to be in an area where I feel I'm making a difference,'' he says. ``I don't want to be another plastic surgeon if they already have tons of those.''
EVMS is encouraging those leaning toward general practice. There's a shortage of doctors doing front-line care - including family practice doctors, pediatricians and internal medicine specialists - say officials with medical schools, insurance companies and the government.
To get more of these doctors, EVMS and Virginia's two other medical schools - the Medical College of Virginia in Richmond and the University of Virginia in Charlottesville - have spent the past two years making big changes in their curricula and, perhaps more importantly, their outlooks. The goal: having half their graduates choose careers in generalist medicine by the time Ryan Cooley graduates.
No one questions the need. In 1994, a group overseeing residency programs said the country, if trends continue, would have 35,000 too few generalists and 115,000 too many specialists by the end of the decade.
UVa created a scholarship for primary care students and changed tenure requirements for professors, making teaching and patient care as important as research.
MCV has aimed its recruiting toward students interested in general practice and has started outreach programs to get high school students thinking about becoming family doctors.
The schools are not only promoting primary care, but also showing medical students how they can be better at it.
EVMS, for example, has trained actors to portray patients, allowing students to practice basic exams and get feedback on technique and manner.
Medical training is a long process: The first class to receive the full four years of the program doesn't graduate until 1998. Even those who finished over the past two years and had some exposure to the program may not have decided yet what they want to do.
EVMS knows that 46 of its 99 most recent graduates are serving their residencies in primary care programs. But some may sub-specialize after their residencies - becoming, for example, a pediatric cardiologist. So the number who actually become primary care doctors may be lower.
Dr. Verdain Barnes, chairman of EVMS' Department of Medicine and director of the school's Center for Generalist Medicine, said he thinks the program has influenced students' choices. ``But if I were asked to prove that to you, I couldn't do that,'' he said.
It's also hard to say whether students choosing primary care are influenced by the generalist initiative or by market forces and society's needs.
In the 1960s, the federal government started programs to head off a predicted shortage of doctors. Now there may be too many doctors; schools are cutting residency programs, and some policy-makers argue that some medical schools should close.
But if students really want to be surgeons, said Barnes, there's no point persuading them to pursue internal medicine.
``They won't be happy. They won't be good at it,'' he said. ``And we need good surgeons.''
LENGTH: Medium: 68 linesby CNB