Making Primary Care a Primary Concern

In an attempt to ease New Jersey's shortage of primary care doctors, the state's teaching hospitals are increasing the number of residencies they offer in that discipline.

It's a necessary effort. But with fewer than 20 new positions all told, it's nowhere near to making a dent in the 1,500 primary care physicians needed in the state by 2014. That's when 600,000 currently uninsured New Jerseyans will be eligible for government-subsidized coverage under the Affordable Care Act -- and will start looking for doctors.

The ACA itself it helping with the problem. A five-year, $10.5 million grant is funding primary care residencies at Cooper University Hospital, Newark Beth Israel Medical Center, and the University of Medicine and Dentistry of New Jersey. And a $795,000 five-year grant to the Cooper Medical School of Rowan University will help ensure new students will begin their training by serving one day a week in the school's primary care clinic.

Dr. Thomas A. Cavalieri, dean of the UMDNJ medical school in Stratford, said expanding the school's primary care residency program will result in 10 more family practice doctors being trained in the next five years. Still, Cavalieri estimates that by 2020 New Jersey will be short about 3,000 doctors, and about half the shortage will be in primary care. He said that over the past five years his school has increased enrollment 50 percent, and now admits 150 students a year, up from 100.

Cavalieri aggressively recruits New Jersey students, who make up 85 percent of the student body. He also works with New Jersey hospitals to develop family medicine residencies. “There is a lot of data that suggests where doctors do their residency training, they are likely to practice,” and his goal is to encourage his students to stay in New Jersey.

That may be looking on the brightest side of things. According to the 2010 survey of graduating residents by the New Jersey Council of Teaching Hospitals, only 37 percent of New Jersey’s graduating physicians planned to establish their practice in the state last year.

“Our school is noted for its emphasis on primary care,” Cavalieri continued. “We have very excellent faculty role models in family medicine. One thing that influences the field you go into is this issue of mentorship. A great role model will attract you into the field.”

Dr. Paul Katz, dean of CMSRU, said studies suggest that as much as half the national doctor shortage that looms in 2014 will be in primary care. But he suggests the problem may not be solved all that easily.

“It’s a tough time to be a primary care physician.” Katz said. Specialists earn more, and that is a big factor when choosing a career—since doctors can easily rack up more than $100,000 in student debt by the time they begin practicing medicine for a living. “We can’t control the difference in reimbursements between primary care physicians and specialty surgeons. But we can introduce our students to what it means to be a primary care physician and the opportunities and joys associated with that, and do so very early in their careers."

Katz, like Cavalieri, believes that mentors can make a very real difference to primary care residents. One example: Dr. Jeff Brenner, who is on the staff of Cooper University Hospital and has a national reputation for the work he is doing as leader of the Camden Coalition of Health Care Providers, which is trying to improve preventative care in the city, and reduce reliance by Medicaid patients on hospital emergency rooms.

Continue reading this story in NJ Spotlight.

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