THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Monday, September 2, 1996 TAG: 9609020038
SECTION: LOCAL PAGE: B1 EDITION: FINAL
SOURCE: BY MARIE JOYCE, STAFF WRITER
LENGTH: 109 lines
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 know they really have a need for those,'' he says. ``I want to be in an area where I feel I'm making a difference. I don't want to be another plastic surgeon if they already have tons of those.''
EVMS is encouraging those leanings toward general practice. There's a shortage of doctors doing front-line care, say officials with medical schools, insurance companies and the government. This includes family practice doctors, who see children and adults; pediatricians, who treat children; and internal medicine specialists, who provide care to adults.
America needs more physicians to treat your kid's sore throat and chide you about your weight.
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 last two years making big changes in their curriculums and, maybe 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 that, if trends continued, the country would have 35,000 too few generalists and 115,000 too many specialists by the end of the decade.
Yet, as the class of 2000 enters its first year, no one knows whether the schools will meet those goals. People running the generalist programs question how valid the 50 percent figure is to begin with.
And some warn that we could swing too far in the other direction. Fifteen years from now, will we have trouble getting a bypass procedure because there aren't enough cardiac surgeons around?
To sell students on general practice, the schools have been putting them into primary care doctors' offices early, to show them the rewards of front-line care.
Organizers hope to disprove the stereotypes: that primary care is dull and unfulfilling, that specialties like surgery are glamorous and more rewarding.
U.Va. created a scholarship for primary care students and changed tenure requirements for professors, making teaching and patient care as important as research.
MCV has targeted its recruitment toward students interested in general practice, and has started outreach programs designed 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.
The schools have started courses on coping with psychological problems of patients, a need often faced by family doctors, and business management of a medical practice, something doctors at fancy academic centers don't worry about.
Whether these efforts have succeed is up to interpretation. There are no good numbers yet.
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 last two years, and had some exposure to the program, may not have decided what they want to do yet.
EVMS knows that 46 of its 99 most recent graduates to go into residencies entered 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 probably will be lower.
Dr. H. Verdain Barnes, chairman of EVMS' Department of Medicine and director of the school's Center for Generalist Medicine, said he believes 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.
``There are residents in anesthesia on the West Coast who are driving taxicabs at this point because they can't find jobs,'' said Betsy Brinson, coordinator of MCV's program.
U.Va. regards the 50 percent number as a guideline, not a fixed target. ``I don't think anybody really knows what the right percent is,'' said Lisa Rollins, coordinator of U.Va.'s program.
The schools can't know exactly what society will need, said Barnes.
We may be overcompensating.
``By the year 2020, at the current rate, we may have more primary care people than we need,'' said Barnes.
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.
``Once you start the pendulum swinging, it tends to swing all the way,'' said Barnes.
But that won't happen in the near future. The three medical schools plan to apply for another three-year grant from the same foundation that financed the start-up. They also hope for continued state funding.
Eventually, Barnes thinks, EVMS could have 60 percent of the class going into general practice within a few years.
The other percent will be needed, too.
Joanna Steele, Ryan Cooley's classmate, probably will be in that 40 percent. She has worked in a hospital emergency room and wants to return. She knows about the push for primary care.
``I don't want to get caught up in the red tape and let (that) keep me from doing what I want to do,'' she says.
If someone really wants to be a surgeon, said Barnes, there's no point persuading him to pursue internal medicine.
``They won't be happy. They won't be good at it,'' he said. ``And we need good surgeons.''
KEYWORDS: MEDICAL SCHOOL by CNB