Re: New Allopathic Medical Schools Train Fewer Family Physicians than Older Ones

To the Editor: Despite years of recommendations for correcting the shortage of primary care physicians, the struggle to coax students into primary care remains.^1,2 Creation of new medical schools has not been the answer, as reported by Beachler et al.³ Drowos⁴ wisely calls on leaders to consider why certain medical schools “are successful at recruiting medical students into family medicine…”; We think we know—it is more about mission and culture than strategy.

The University of Alabama's College of Community Health Sciences (CCHS) has provided clinical year medical education as the Tuscaloosa Regional Campus (TRC) of the University of Alabama School of Medicine (UASOM) since 1972. Founding Dean, William R. Willard, MD, of the “Willard Report,”⁵ shaped the College in response to a desperate call for family physicians, infusing a deeply held sense of mission from which we have not strayed.

Many medical schools report optimistic though misleading data on its graduates' match into primary care,⁶ failing to adjust for the attrition of up to 80% of residents into subspecialties, particularly in internal medicine and pediatrics.⁷ What distinguishes our data are that we have been able to track all 850 UASOM graduates who trained at the TRC over 4 decades to verify their practice location and specialty.

Some 440 graduates (52%) who trained at the TRC between 1974 and 2015 matched into primary care fields. Of these, 345 (47%) practiced primary care for a “retention in primary care” rate of 78%. Retention was highest for those who trained in Family Medicine (98%), followed by Pediatrics (71%), Internal Medicine (62%), then Internal Medicine/Pediatrics (36%). This is the highest retention rate for the 3 campuses of UASOM, which trained students during this time frame (Birmingham rate, 45%; Huntsville rate, 52%). Of note, retention rates for General Internal Medicine (TRC, 62%; Birmingham, 29%; Huntsville, 24%), and for General Pediatrics (TRC, 71%; Birmingham, 59%; Huntsville, 52%), suggests a broad effect that is not specialty specific.

The authors have experienced this sense of mission over our own 40 years of personal history with CCHS. The majority of CCHS deans have been primary care physicians; graduate medical education at CCHS is limited to Family Medicine; research is focused on community and rural issues and prematriculation, rural and minority pipeline programs emphasize primary care and service to rural communities. Learners have the breadth, role, ability and collaborative style of the generalist reinforced as they work with all CCHS faculty of all specialties.

The late management sage, Peter Drucker, is said to have articulated that culture eats strategy for breakfast. Forty years of data from one of the country's older regional campuses supports that notion.