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Family Practice Specialty Staging Comeback in U.S. Medical Schools : Medicine: Turnaround comes at a time when health care experts and the Clinton Administration are pressing for fewer specialists and more primary care physicians.


KANSAS CITY, Mo. — When Derek Williams went to medical school, he wanted to specialize in cardiology or general surgery.

Three years later, during his first year of residency at the University of Kansas Medical Center, Williams is committed to becoming a family doctor.

"Eventually I started to realize that all the specialties interested me in some way," Williams said. "And I saw that with family medicine, I could do a little bit of everything."

Michelle Britton-Mehlisch, who originally planned to specialize in obstetrics-gynecology, also changed her mind and is now in her second year of residency in family practice at the medical center. The chance to establish long-term relationships with patients was an important factor in her decision.

"I saw that family practice would let me treat a wide range of ages and a lot of medical conditions, including pediatrics," Britton-Mehlisch said. "Rather than just treat the acute problems, I would have a chance to follow patients all through their lives."

Williams and Britton-Mehlisch are examples of what's happening in medical schools nationwide, at a time when health care experts and the Clinton Administration are pressing for fewer specialists and more primary care physicians.

"It has been a wonderful three or four years for family practice medicine," said Dr. William Coleman, president of the American Academy of Family Physicians, based in Kansas City.

A recent national convention in Kansas City sponsored by the academy drew almost 900 family practice-oriented students and 600 residents--more than any such gathering ever held in the country, Coleman said.

Perhaps just as important, the convention attracted 100 more exhibitors and recruiters than had ever attended similar conventions, a sign of changing attitudes in medical schools, he said.

Family practice doctors generally haven't received professional respect because they don't make as much money or do the highly specialized research that brings fame and funds to medical schools, Coleman said.

Now, many medical schools are adding family physicians to their staffs to serve as role models and mentors for students, he said.

"The role models are moving away from being the high-technology physicians, such as a heart surgeon, to physicians who can really interact with patients and do a lot of different medical procedures," Coleman said. "That is very important for students."

For example, Britton-Mehlisch said she often was told during medical school that she was "too smart" to go into family practice.

"The students I talk to aren't hearing that as much now," she said. "Even the specialists realize that the trend toward primary care is here to stay, and they are tending to be more supportive."

Dr. William Jacott, a family physician at the University of Minnesota in Minneapolis and a member of the Board of Trustees of the American Medical Assn., said health care reform, which has encouraged more managed-care organizations, has been a factor in changing attitudes.

"Managed care has to have a case manager who directs the activity of the patient," Jacott said. "That's clearly a signal we need more family physicians. . . . Society is saying we need to move in this direction. And when society speaks, Congress tends to find funding and medical schools tend to develop programs to respond."

Congress has begun to favor primary care physicians--family doctors, internists and pediatricians--when directing funds for education programs and student loans. For instance, the federal government offers 3% loans to primary care students, while students in some specialties pay 15%.

Other programs forgive all or part of a student's loans or tuition if they choose family practice.

The incentives seem to be working.

Only 15 of the 126 medical schools in the country have no family practice program or presence, Jacott said.

Coleman said 8,531 people were in family practice residencies as of July 1, with 411 residencies available. Both of those numbers are the highest ever recorded in the country, he said.

At the end of their four-year medical curriculum, students are matched with residency positions in their chosen specialties at teaching hospitals.

The academy estimates that 4,000 general physicians are needed to fill shortages of doctors in 2,000 communities nationwide. The shortages are the worst in rural and inner-city areas.

The academy is pushing the government to work even harder to influence the medical Establishment to put a higher priority on training family physicians.

Suggested incentives include requiring that at least half of the training slots in residency programs be in primary care areas, changing federal policies to get more direct funding of family practice and ensuring that Medicare provides more equitable reimbursement in rural areas.

The AMA supports plans to increase primary care physicians, although with some caution, Jacott said. "We'll still need specialists," he said. "We don't want to be without neurosurgeons," for example.

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