To the Editor:
We read your editorial from the May 2008 issue of Academic Medicine with great interest. We agree that it is time to look again at what premedical requirements are needed to attract the most appropriate students for a career in medicine. As family medicine teachers of medical students, we are concerned that the current premedical requirements particularly discourage students who may choose primary care as a career. We struggle with the declining interest in primary care, especially family medicine, every day. We feel that, given the importance of primary care for any health system,1 the declining numbers of primary care physicians represent a real crisis in health care. There are many areas, particularly in rural America, that have poor access to health care. Family physicians provide not only an invaluable service in underserved areas but also the most service compared with that given by other primary care specialists.2 In fact, family medicine physicians are currently the most-recruited physicians in the country. Students who are often attracted to family medicine are older, from rural areas, and come from a lower socioeconomic status,3 but in some schools, admission requirements that may be disadvantageous to these students exacerbate the lack of primary care interest. Also, bright, creative, and humanistic students, whether or not they aced organic chemistry,4 should be especially encouraged to apply to medical school, where, hopefully, they will choose primary care careers.
We appreciate your bringing forward the discussion of medical school admission criteria, but we feel strongly that we need to expand the discussion to talk about how to recruit and what incentives medical schools can give to premedical students who are more likely to go into primary care and family medicine.
Katherine Margo, MD
Past chair, Group on Predoctoral Education (GPE) of the Society of Teachers of Family Medicine (STFM), and director of student programs, Department of Family Medicine and Community Health, University of Pennsylvania School of Medicine, 2 Gates/3400 Spruce St., Philadelphia, PA 19104; ([email protected]).
Chantal Brazeau, MD
Chair, GPE/STFM, associate professor of psychiatry and family medicine, and director of predoctoral education, Department of Family Medicine, UMDNJ–New Jersey Medical School, Newark, NJ.
Christine Jerpbak, MD
Chair Elect, GPE/STFM, and director of predoctoral education, Department of Family and Community Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA.
1 Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005;83:457–502.
2 Fryer GE, Dovey SM, Green LA. The United States relies on family physicians, unlike any other specialty. One pager no. 5. Washington, DC: Robert Graham Center; 2000. Available at: (http://www.graham-center.org/x160.xml
). Accessed June 1, 2008.
3 Senf J, Campos-Outcalt D, Kutob R. Factors related to the choice of family medicine: A reassessment and literature review. J Am Board Fam Pract. 2003;16:502–512.
4 Lovecchio K, Dundes L. Premed survival: Understanding the culling process in premedical undergraduate education. Acad Med. 2002;77:719–724.