New Jersey’s family doctors are seeking a cure for their thin ranks from the source of many of the state’s doctors – its medical schools.
Of New Jersey’s doctors, only 7 percent practice family medicine, according to the American Academy of Family Physicians. The state is tied with Maryland for the fourth-lowest percentage in the country, after Connecticut, Massachusetts and New York.
The New Jersey Academy of Family Physicians, in its dealings with state officials, has made encouraging more medical students to choose family medicine one of its priorities. Those efforts may lead to additional legislation, but family-medicine lobbyists said their primary goal is encouraging medical schools to make the specialty a priority.
Two of the state’s medical school deans said they understand the importance of the issue and are already taking steps to attract more students to family medicine. But they’re also wary of putting the entire burden on medical schools, noting that outside factors like the higher pay that subspecialists receive play a large role in the career decisions of highly indebted medical school graduates.
NJAFP government affairs director Claudine M. Leone said the state could direct the medical schools to allot a larger share of their budgets to family medicine, as well as provide additional funding for medical-school programs that attract applicants who are interested in family medicine.
“We’re trying to figure out the best way to motivate the medical schools” to develop plans to increase family-medicine interest, Leone said. She later said that the doctors would prefer to see the schools make these changes without legislative inducement.
At the University of Medicine and Dentistry of New Jersey’s Robert Wood Johnson Medical School in New Brunswick, family medicine department chairman Dr. Alfred E. Tallia said the school has been making progress, but it’s challenging.
“This is a problem that’s literally fifty years in the making,” Tallia said. “It’s my belief, and it’s a belief based on studies that have been done around the country, that it’s largely an economic problem.”
The median starting salary for family doctors nationally is $138,000, the lowest of any specialty, with salaries for other specialties ranging as high as $465,000 for orthopedic surgeons who specialize in spinal surgery, according to survey by Profiles, a Missouri company that serves the physician recruitment industry.
Tallia said there have been signs of progress in other states, as the demand for family doctors increases. But this is “doubly problematic for New Jersey because the state is now competing with the rest of the country,” he said.
Tallia said the large number of one- or two-doctor practices in New Jersey makes it impractical for many practices to increase entry-level salaries.
“They just don’t have the financial wherewithal of larger organizations, particularly hospitals, to offer larger salaries,” Tallia said.
However, Tallia said, Robert Wood Johnson Medical School’s family medicine department is one of the largest in the country and is well-positioned to encourage more students to enter family medicine.
“The medical school environment has really changed in the last couple of years, so that family medicine is now an equal among the other medical school departments,” Tallia said.
This is partly due to its research in patient-centered medical home (PCMH) model, which it has shared with the state’s largest insurer, Horizon Blue Cross/Blue Shield of New Jersey.
Dr. Steven Peskin, a medical director for Horizon, said having more primary-care providers is the foundation of all patient care. Peskin has worked with Tallia on the PCMH model, in which primary-care doctors are paid to coordinate care with other doctors and to focus on preventive care. This reduces some of the pressure to see as many patients as possible under a pure fee-for-service model, in which the doctor is paid for each service provided, Peskin said. Therefore, he added, the PCMH approach can be more professionally rewarding.
“It creates the right kind of environment that primary care physicians appreciate and truly value,” Peskin said.
Another area where Robert Wood Johnson Medical School is attempting to improve is in the application process. The demographics of students interested in family medicine are unique – they tend to come from more rural backgrounds and do not have other doctors in the family.
“The problem we have in New Jersey is there’s not too many rural places that we can draw from,” Tallia said, adding that the school has created an intensive applicant interview process that tends to highlight those students with the strongest interpersonal skills – a group which also tends to be interested in family medicine and other primary care careers. The school also has developed a special primary care track, which gives interested students more exposure to primary care subjects in the curriculum.
Tallia said the state could play a positive role by expanding its loan forgiveness program for primary care providers. This is supported by Leone and Raymond J. Saputelli, executive director of the NJAFP.
In Camden, Rowan University’s Cooper Medical School Dean Paul Katz said family medicine is fundamental to the new school, which launched with its first class this fall.
“Part of why we’re here is to repopulate the physician workforce,” Katz said.
He noted that the school’s location in the heart of Camden has also attracted students who want to serve as primary care providers in high-need areas.
He said one obstacle is that many students have more early medical-school experiences with subspecialists. He also said it’s unfortunate that some doctors who serve as mentors to students discourage them from pursuing family medicine.
Robert Wood Johnson Medical School Dean Dr. Peter S. Amenta said the school is doing what it can to encourage family-medicine students. This includes giving several $10,000 scholarships to third-year students studying family medicine.
“It’s not going to change the financial framework over time, but I think it’s a step in the right direction,” Amenta said.
He added that graduate debt remains an obstacle.
“There are things you can control and things you can’t control. One of the things I can’t control is what the compensation is once they graduate from medical school. You’re coming out with a debt of $160,000-plus,” Amenta said. “What you owe is basically a mortgage on a house in the good old days.”