Revitalizing General Practice: The Critical Role of Medical Schools in Addressing the Primary Care Physician Shortage
Abstract
:1. Introduction
2. The Role of Medical University Systems
Modernizing Curricula at Established Medical Universities
3. The Challenges of Establishing New Medical Schools
3.1. Sociopolitical Factors and the Abandoned Medical School Initiative in South Tyrol, Italy
3.2. Institutional Resistance in the Medical School Initiative in Tyrol, Austria
4. Potential Solutions
4.1. Modernizing Curricula in Existing State Medical Schools
4.2. Fostering Collaboration and Supporting New Medical Schools
4.3. Policy Innovations for Empowering New Medical Schools
5. Learning from the Past and Moving Forward
5.1. Collaborative Dialogues: Bridging Disciplines and Perspectives
5.2. Call to Action
6. Conclusions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Hanson, K.; Brikci, N.; Erlangga, D.; Alebachew, A.; Allegri, M.D.; Balabanova, D.; Blecher, M.; Cashin, C.; Esperato, A.; Hipgrave, D.; et al. The Lancet Global Health Commission on Financing Primary Health Care: Putting People at the Centre. Lancet Glob. Health 2022, 10, e715–e772. [Google Scholar] [CrossRef] [PubMed]
- Physician Workforce Projections the Complexities of Physician Supply and Demand: Projections from 2019 to 2034. Available online: https://www.aamc.org/data-reports/workforce/data/complexities-physician-supply-and-demand-projections-2019-2034 (accessed on 9 May 2023).
- Organisation for Economic Co-operation and Development. Health at a Glance: Europe 2022: State of Health in the EU Cycle. Available online: https://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance-europe-2022_507433b0-en (accessed on 9 May 2023).
- Mahlknecht, A.; Engl, A.; Barbieri, V.; Bachler, H.; Obwegeser, A.; Piccoliori, G.; Wiedermann, C.J. General Practice as a Career Choice: Cross-Sectional Survey of Attitudes and Influential Factors among Medical Students and Residents in Tyrol, Austria. SSRN 2023. [Google Scholar] [CrossRef]
- Buddeberg-Fischer, B.; Klaghofer, R.; Abel, T.; Buddeberg, C. Swiss Residents’ Speciality Choices—Impact of Gender, Personality Traits, Career Motivation and Life Goals. BMC Health Serv. Res. 2006, 6, 137. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Smith, S.R. A Recipe for Medical Schools to Produce Primary Care Physicians. N. Engl. J. Med. 2011, 346, 496–497. [Google Scholar] [CrossRef]
- Frenk, J.; Chen, L.; Bhutta, Z.A.; Cohen, J.; Crisp, N.; Evans, T.; Fineberg, H.; Garcia, P.; Ke, Y.; Kelley, P.; et al. Health Professionals for a New Century: Transforming Education to Strengthen Health Systems in an Interdependent World. Lancet 2010, 376, 1923–1958. [Google Scholar] [CrossRef] [Green Version]
- Erikson, C.E.; Danish, S.; Jones, K.C.; Sandberg, S.F.; Carle, A.C. The Role of Medical School Culture in Primary Care Career Choice. Acad. Med. 2013, 88, 1919–1926. [Google Scholar] [CrossRef]
- Kim, D.T.; Applewhite, M.K.; Shelton, W. Professional Identity Formation in Medical Education: Some Virtue-Based Insights. Teach. Learn. Med. 2023, 1–11. [Google Scholar] [CrossRef]
- Cooke, M.; Irby, D.M.; O’Brien, B.C. Educating Physicians: A Call for Reform of Medical School and Residency; John Wiley & Sons: Hoboken, NJ, USA, 2010; Volume 16, ISBN 0-470-45797-X. [Google Scholar]
- Wass, V.; Gregory, S.; Petty-Saphon, K. By Choice—Not by Chance. Supporting Medical Students towards Future GP Careers; Health Education England; Medical Schools Counsil: London, UK, 2016; pp. 1–56. [Google Scholar]
- Scott, I.; Wright, B.; Brenneis, F.; Brett-Maclean, P.; McCaffrey, L. Why Would I Choose a Career in Family Medicine?: Reflections of Medical Students at 3 Universities. Can. Fam. Physician 2007, 53, 1956–1957. [Google Scholar]
- Seehusen, D.; Raleigh, M.; Phillips, J.; Prunuske, J.; Morley, C.; Polverento, M.; Kovar-Gough, I.; Wendling, A. Institutional Characteristics Influencing Medical Student Selection of Primary Care Careers: A Narrative Review and Synthesis. Fam. Med. 2022, 54, 522–530. [Google Scholar] [CrossRef]
- Bleakley, A. Blunting Occam’s Razor: Aligning Medical Education with Studies of Complexity. J. Eval. Clin. Pract. 2010, 16, 849–855. [Google Scholar] [CrossRef]
- Hehli, S.; Zaslawski, V. Neue Medizin-Fakultäten: Wie Pilze Aus Dem Boden. Neue Zürcher Zeitung. 2016. Available online: https://www.nzz.ch/schweiz/neue-medizin-fakultaeten-wie-pilze-aus-dem-boden-ld.103482?reduced=true (accessed on 12 May 2023).
- Innerhofer, J.E. Privatuniversitäten in Österreich: “Dr. Med.” Für 72000 Euro. Die Zeit. 2017. Available online: https://www.zeit.de/2017/09/privatuniversitaeten-oesterreich-markt-wachstum? (accessed on 12 May 2023).
- Austrian Press Agency Sigmund-Freud-Privat-Uni verliert Zulassung für Medizin-Masterstudiengang. Der Standard. 2022. Available online: https://www.derstandard.at/story/2000141113026/sigmund-freud-privatuni-verliert-zulassung-fuer-medizin-masterstudium (accessed on 12 May 2023).
- Peterlini, O. The South-Tyrol Autonomy in Italy: Historical, Political and Legal Aspects. In One Country, Two Systems, Three Legal Orders—Perspectives of Evolution; Springer: Berlin/Heidelberg, Germany, 2009; ISBN 978-3-540-68571-5. [Google Scholar]
- Eichinger, L. South Tyrol: German and Italian in a Changing World. J. Multiling. Multicult. Dev. 2002, 23, 137–149. [Google Scholar] [CrossRef] [Green Version]
- Riehl, C.M.; Hajek, J. Language Policy and Reality in South Tyrol. In Uniformity in Diversity in Language Policy: Global Perspectives; Multilingual Matters: Chatham, ON, Canada, 2011; pp. 210–225. [Google Scholar]
- Fink, R.L.; Robinson, R.K.; Wyld, D.C. English-Only Work Rules: Balancing Fair Employment Considerations in a Multicultural and Multilingual Healthcare Workforce. Hosp. Health Serv. Adm. 1996, 41, 473–483. [Google Scholar] [PubMed]
- Hausmittel gegen Ärztemangel. Dolomiten-Tagblatt der Südtiroler. 2012. Available online: https://abo.athesiamedien.com/epaper/magazines/634-dolomiten-vom-16-10-2012?search=Haumittel+gegen+%C3%84rztemangel#page=1 (accessed on 12 May 2023).
- Medical School Trilingue: Ecco Il Progetto. Alto Adige, 25 October 2012.
- Brücke Zur Eigenen Medizin-Uni. Abkommen: Südtirol Und Lombardei Besiegeln Zusammenarbeit Im Gesundheitswesen—Umsetzung Startet Im Jänner 2012. Dolomiten-Tagblatt der Südtiroler, 23 December 2011. [Google Scholar]
- Aschbacher, A. Das Medizin-Phantom. Die Pläne Für Eine Eigenen Medical School Entzweien Das Land; ff-Das Südtiroler Wochenmagazin: Bolzano, Italy, 2013; pp. 22–26. [Google Scholar]
- Ärzte-Ausbildung in Südtirol: STF und Freiheitliche Kritisch. Available online: https://www.suedtirolnews.it/politik/freiheitliche-suedtirol-braucht-keine-schmalspurmediziner-2 (accessed on 12 May 2023).
- Disput um weitere Medizinerausbildung. Tirol ORF News. 2016. Available online: https://tirol.orf.at/v2/news/stories/2766689/ (accessed on 12 May 2023).
- Baltaci, K. Tirol Plant Zweite Medizinuniversität; Die Presse: Vienna, Austria, 2016. [Google Scholar]
- Tyrolean Medical School: 2. Anlauf. Dolomiten-Tagblatt der Südtiroler, 1 June 2016.
- Redaktion Südtirol Will Sich an Medical School Beteiligen. Available online: https://www.rainews.it/tgr/tagesschau/articoli/2018/09/tag-Medical-School-Arzt-Medizin-Ausbildung-e7940fa7-939e-4229-a7d0-f5d74f783e61.html (accessed on 12 May 2023).
- Raleigh, M.; Seehusen, D.; Phillips, J.; Prunuske, J.; Morley, C.; Polverento, M.; Kovar-Gough, I.; Wendling, A. Influences of Medical School Admissions Practices on Primary Care Career Choice. Fam. Med. 2022, 54, 536–541. [Google Scholar] [CrossRef]
- Arora, S.; Egyed, M.-T.; Kogelnik, L. Privatunis: Vorbehalte Gegen “Med-Unis Light”. Der Standard. 23 February 2017. Available online: https://www.derstandard.at/story/2000053030649/privatunis-vorbehalte-gegen-med-unis-light (accessed on 12 May 2023).
- Weilguni, V. Private MedUnis Verkaufen Den Traum Vom Arztberuf. Ärzte Woche, 28 April 2016; p. 2. [Google Scholar]
- Medical School: Geld und Gegner. Dolomiten-Tagblatt der Südtiroler, 22 July 2016.
- Redaktion Medical School Adé. Available online: https://www.rainews.it/tgr/tagesschau/articoli/2020/01/tag-Thomas-Widmann-Gesundheit-Aerztemangel-Ausbildung-Cattolica-Salzburg-f16b38e7-03b8-4ac3-a268-ddc6e21dda4f.html (accessed on 12 May 2023).
- Persada, S.F.; Prasetyo, Y.T.; Suryananda, X.V.; Apriyansyah, B.; Ong, A.K.; Nadlifatin, R.; Setiyati, E.A.; Putra, R.A.K.; Purnomo, A.; Triangga, B. How the Education Industries React to Synchronous and Asynchronous Learning in COVID-19: Multigroup Analysis Insights for Future Online Education. Sustainability 2022, 14, 15288. [Google Scholar] [CrossRef]
- Seal, A.N.; Playford, D.; McGrail, M.R.; Fuller, L.; Allen, P.L.; Burrows, J.M.; Wright, J.R.; Bain-Donohue, S.; Garne, D.; Major, L.G.; et al. Influence of Rural Clinical School Experience and Rural Origin on Practising in Rural Communities Five and Eight Years after Graduation. Med. J. Aust. 2022, 216, 572–577. [Google Scholar] [CrossRef]
- Rourke, J. Strategies to Increase the Enrolment of Students of Rural Origin in Medical School: Recommendations from the Society of Rural Physicians of Canada. CMAJ 2005, 172, 62–65. [Google Scholar] [CrossRef] [Green Version]
- Bolzano Prepares His School of Medicine and as a Partner He Prefers Cattolica to the University of Trentino—Cronaca. Available online: https://www.breakinglatest.news/health/bolzano-prepares-his-school-of-medicine-and-as-a-partner-he-prefers-cattolica-to-the-university-of-trentino-cronaca/ (accessed on 12 May 2023).
- Südtiroler Fond zur Förderung der Wissenschaftlichen Forschung (SFPR)|Südtiroler Sanitätsbetrieb. Available online: https://home.sabes.it/de/forschungsfond.asp (accessed on 12 May 2023).
- Medicina a Bolzano: Tavolo di Lavoro Tra Provincia e Univ. Cattolica. Available online: https://news.provincia.bz.it/it/news/medicina-a-bolzano-tavolo-di-lavoro-tra-provincia-e-univ-cattolica (accessed on 12 May 2023).
- World Health Organization. Increasing Access to Health Workers in Remote and Rural Areas through Improved Retention: Global Policy Recommendations; World Health Organization: Geneva, Switzerland, 2010; ISBN 92-4-156401-6. [Google Scholar]
- Cresswell, K.; Sheikh, A.; Franklin, B.D.; Krasuska, M.; Nguyen, H.T.; Hinder, S.; Lane, W.; Mozaffar, H.; Mason, K.; Eason, S.; et al. Interorganizational Knowledge Sharing to Establish Digital Health Learning Ecosystems: Qualitative Evaluation of a National Digital Health Transformation Program in England. J. Med. Internet Res. 2021, 23, e23372. [Google Scholar] [CrossRef]
- Miller, R.; Scherpbier, N.; van Amsterdam, L.; Guedes, V.; Pype, P. Inter-Professional Education and Primary Care: EFPC Position Paper. Prim. Health Care Res. Dev. 2019, 20, e138. [Google Scholar] [CrossRef] [Green Version]
- Lucey, C.R. Medical Education: Part of the Problem and Part of the Solution. JAMA Intern. Med. 2013, 173, 1639–1643. [Google Scholar] [CrossRef]
- Han, E.-R.; Yeo, S.; Kim, M.-J.; Lee, Y.-H.; Park, K.-H.; Roh, H. Medical Education Trends for Future Physicians in the Era of Advanced Technology and Artificial Intelligence: An Integrative Review. BMC Med. Educ. 2019, 19, 1–15. [Google Scholar] [CrossRef] [Green Version]
- Gard, L.A.; Peterson, J.; Miller, C.; Ghosh, N.; Youmans, Q.; Didwania, A.; Persell, S.D.; Jean-Jacques, M.; Ravenna, P.; O’Brien, M.J. Social Determinants of Health Training in US Primary Care Residency Programs: A Scoping Review. Acad. Med. 2019, 94, 135–143. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Bai, H. Modernizing Medical Education through Leadership Development. Yale J. Biol. Med. 2020, 93, 433–439. [Google Scholar] [PubMed]
- Viscomi, M.; Larkins, S.; Gupta, T.S. Recruitment and Retention of General Practitioners in Rural Canada and Australia: A Review of the Literature. Can. J. Rural Med. 2013, 18, 13–23. [Google Scholar] [PubMed]
Topic | Description |
---|---|
Crisis in General Practice | |
Importance of General Practice | Primary care and preventive medicine |
Early detection and management of health conditions | |
Continuity of care and building long-term patient relationships | |
Shortage of Medical Personnel | Declining interest in general practice as a career choice among medical students |
Increasing patient populations and demand for primary care services | |
High workload and burnout among general practitioners | |
Impact of the shortage on patient care, waiting times, and healthcare costs | |
Factors Contributing to the Shortage | |
Medical Education and Training | Medical university system’s focus on specialized and hospital-based care |
Insufficient exposure to general practice during medical education | |
Limited availability of postgraduate training positions in general practice | |
Socioeconomic Factors | Perceived lower prestige and financial rewards compared to specialist roles |
Geographic disparities in the distribution of medical personnel | |
Impact of an aging population and increasing prevalence of chronic diseases | |
Policy and System-Level Factors | Insufficient support for general practice from policymakers and healthcare organizations |
Barriers to establishing new curricula and medical schools focused on general practice | |
Resistance from established medical universities |
Solution | Description |
---|---|
Modernizing Curricula [46] | Incorporate general-practice content and experiences throughout the educational program |
Emphasize community-based and primary care settings | |
Integrate interprofessional education, preventive medicine, and early intervention strategies | |
Employ innovative teaching methodologies, such as problem-based learning, simulation, and digital technologies | |
Fostering Collaboration [47] | Encourage collaboration between established medical schools and new institutions focused on general practice |
Share expertise, resources, and best practices | |
Implement measures that support the establishment of new medical schools dedicated to general practice, such as streamlining the accreditation process, providing financial incentives, and encouraging partnerships with existing schools | |
Policy Innovations [48] | Simplify and expedite the accreditation process for new medical schools prioritizing general practice education |
Offer financial incentives, such as grants, low-interest loans, or tax breaks | |
Foster partnerships between new and established institutions | |
Support integration of interprofessional education and collaboration | |
Provide resources and guidance for community-based education and engagement | |
Establish a centralized body or database to collect, analyze, and disseminate best practices in general practice medical education |
Solution | Description |
---|---|
Developing Regional Partnership | Leverage existing collaborations between South Tyrol health service, Cattolica University, and Paracelsus Medical University |
Create a comprehensive plan for establishing a medical school in the region | |
Develop a cutting-edge curriculum prioritizing general practice and primary care | |
Collaborate on infrastructure, resources, and faculty recruitment | |
Ensure accreditation and recognition at national and international levels |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the author. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Wiedermann, C.J. Revitalizing General Practice: The Critical Role of Medical Schools in Addressing the Primary Care Physician Shortage. Healthcare 2023, 11, 1820. https://doi.org/10.3390/healthcare11131820
Wiedermann CJ. Revitalizing General Practice: The Critical Role of Medical Schools in Addressing the Primary Care Physician Shortage. Healthcare. 2023; 11(13):1820. https://doi.org/10.3390/healthcare11131820
Chicago/Turabian StyleWiedermann, Christian J. 2023. "Revitalizing General Practice: The Critical Role of Medical Schools in Addressing the Primary Care Physician Shortage" Healthcare 11, no. 13: 1820. https://doi.org/10.3390/healthcare11131820
APA StyleWiedermann, C. J. (2023). Revitalizing General Practice: The Critical Role of Medical Schools in Addressing the Primary Care Physician Shortage. Healthcare, 11(13), 1820. https://doi.org/10.3390/healthcare11131820