Q&A: Pennsylvania program offers some students free tuition to increase number of PCPs
There will be a shortage of up to 55,200 primary care physicians by 2033, a problem that may be worsened by the COVID-19 pandemic, according to the American Association of Medical Colleges.
One program intended to boost the number of PCPs is the Geisinger Commonwealth School of Medicine Primary Care Scholars Program, which began earlier this summer. Among other things, the loan forgiveness program at the private medical school in Scranton, Pa., covers 4 years of tuition and fees for up 40 students annually, giving successful applicants a chance to enter the primary care workforce with significantly lower debt than many of their peers.
In a study published in Medical Education Online, Derek K. Rogalsky, MD, and colleagues examined how medical school debt influenced 1,846 medical students in choosing a specialty. He told Healio Primary Care that the results of the study, along with his own personal experiences, have shown him that initiatives like Geisinger’s can help fill the projected PCP gap.
“Within my own class at Georgetown, debt was a strong influence that pushed people away from specialties such as pediatrics and family medicine,” Rogalsky, who is not involved with the Geisinger program, said.
Lawrence R. John, MD, president of the Pennsylvania Medical Society, told Healio Primary Care that he supported the idea of free-tuition incentives as a tool to encourage medical students to go into primary care.
“Primary care physicians make a salary reflective of their years of education and training which is consistent with many other professions,” said John, who is also not affiliated with Geisinger. “However, unlike other careers, they are saddled with an average medical school debt of $200,000 and do not start making money until their late 20s or early 30s. Freeing medical students of this enormous debt will encourage more of them to enter the vitally important field of primary care.”
Healio Primary Care spoke with Steven J. Scheinman, MD, FACP, FASN, president and dean of the Geisinger Commonwealth School of Medicine, to provide more insight into the program’s development, how students are chosen, its curriculum and more.
Q: How did Geisinger’s Primary Care Scholars Program come about?
A: Geisinger has its roots in rural Danville, Pennsylvania. It still has a presence there and in other small communities. But in recent decades it has expanded its coverage area to include Scranton and Wilkes-Barre, Pennsylvania, Atlantic City, New Jersey, and the suburbs of Philadelphia.
Our Primary Care Scholars Program, modeled after the Military Loan Repayment Program, addresses two serious challenges facing health care: The shortage of primary care physicians in this region and nationally, and the enormous debt that students have upon graduation from medical school.
We have been working hard on creating scholarships that address medical students’ debt for years. Over time, our leadership team broadened that approach to include service components. We structured a program to enhance primary care that also included mechanisms of funding and the mechanisms of implementation.
Besides the tuition waiver, successful applicants also receive a $2,000 monthly stipend for all 4 years of medical school. They can complete their residency at the institution of their choosing, but must choose a family medicine, internal medical or pediatrics program. After their residency training, they must work for the Geisinger Health System for 4 years.
Q: How does the program prepare PCPs for the rapidly changing scope of the profession?
A: Though it was designed with the needs of Geisinger’s communities in mind, it also emphasizes nationwide initiatives such as precision health, population health, social determinants of health, preventive health and promoting good health. Students in this program receive a curriculum that is enriched in experiences in Geisinger’s signature primary care programs.
Some of the innovative programs within Geisinger include Primary Care Redesign, which concentrates on team-based care, population identification, and risk stratification while weaving in analytic support and electronic medical record solutions. Another program, Fresh Food Farmacy, offers “prescriptions” for no-cost nutritious food to food-insecure patients with diabetes, with the objective of keeping the disease under control.
A third program, Geisinger 65 Forward, meets the needs of those aged 65 years and older. Patients in this program receive longer appointments, social activities, wellness classes and VIP-level, personalized care. Our Geisinger at Home program emphasizes care for patients with challenging, difficult-to-manage health conditions in the patient’s home. Another program is the MyCode Community Health Initiative, a precision medicine project that examines the DNA of volunteers to diagnose medical conditions — sometimes before symptoms appear — and helps find new treatments or medications to manage these diseases.
Programs like this may sound expensive, but in an integrated care delivery system like Geisinger, which is also their insurer by promoting better health.
In addition, all Geisinger Primary Care Scholars Program are assigned a Geisinger clinician as an adviser for their 4 years. They also could pursue research projects with Geisinger investigators.
Q: How are applicants chosen?
A: All applicants must complete traditional and American Medical College Application Service applications and a Private Education Loan Applicant Self-Certification Form. They must also provide their curriculum vitae, a letter of recommendation and an essay that answers: “What would this scholarship mean to you regarding the advancement of your professional goals as a primary care physician?”
We also look at applicants’ financial need, merit — a combination of academic performance, service and other characteristics, such as a desire to work within Geisinger’s footprint — and the probability of an applicant staying at Geisinger beyond their service obligation.
Q: How will you decide if the program is a success?
A: Some of the ways include the number of students we make interested in primary care and how many of these students stay with Geisinger after their obligation.
Q: How does the Primary Care Scholars Program fit into other initiatives attempting to fill physician shortages ?
A: A program that generates, at most, 40 PCPs, will have a very small effect nationally, but could have a great impact regionally.
However, studies show levels of school-related debt correlate with job performance. Burnout correlates with medical error. We are certainly taking a major step to relieve the debt of our students and giving them a stronger ability to focus their minds on their work.
Another very important factor in keeping students in medicine is their role models. Physicians who serve as mentors in the Primary Care Redesign, Fresh Food Farmacy, Geisinger 65 Forward and the MyCode Community Health Initiative tell me these programs have restored the meaning and joy in their work and their relationships with patients. If students see physicians in one specialty unhappy, stressed and burned out, and professionals in another specialty happy, resilient and satisfied, the students are likely going to gravitate in the latter direction. We hope that by creating a program like ours and by creating the curriculum that we have perhaps other institutions might follow our lead.
Editor’s note: This article is part of a n ongoing series spotlighting people and institutions who are making innovat ions in primary care. If you or your institution are taking important steps to improve the quality and cost of care in the primary care setting, email us at firstname.lastname@example.org.
- AAMC.com. Physician supply and demand: A 15-Year outlook: Key findings. https://www.aamc.org/system/files/2020-07/aamc-2020-workforce-projections-15-year-outlook-key-findings-f2.pdf. Accessed July 2, 2020.
- AAMC.com. U.S. physician shortage growing. https://www.aamc.org/news-insights/us-physician-shortage-growing. Accessed July 2, 2020.
- Geisinger Commonwealth School of Medicine. About Geisinger Commonwealth School of Medicine. https://www.geisinger.edu/education/about/about-geisinger-commonwealth-school-of-medicine. Accessed July 2, 2020.
- Geisinger Commonwealth School of Medicine. Frequently asked questions. Geisinger Primary Care Scholars Program. https://www.geisinger.edu/education/admissions/financial-aid/geisinger-scholar-programs/geisinger-primary-care-scholars-program/geisinger-primary-care-scholars-faq. Accessed July 2, 2020.
- Geisinger Commonwealth School of Medicine. Geisinger Primary Care Scholars Program application. https://www.geisinger.edu/education/admissions/financial-aid/geisinger-scholar-programs/geisinger-primary-care-scholars-program. Accessed July 2, 2020.
- Rohlifing J, et al. Med Educ Online. 2014;doi: 10.3402/meo.v19.25603.
- Tanne JH. BMJ. 2018;doi:10.1136/bmj.k3588.