Medical Education:

Curriculum and Financing Strategies Need to Encourage Primary Care Training

HEHS-95-9: Published: Oct 21, 1994. Publicly Released: Oct 25, 1994.

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Bernice Steinhardt
(202) 512-7119


Office of Public Affairs
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Pursuant to a congressional request, GAO reviewed the role of medical education in physician specialty choices, focusing on: (1) the students who are more likely to choose generalist or primary care specialties in medical school; (2) the curriculum requirements that expose medical students and residents to primary care training; and (3) how federal financing of medical education influences students' career choices.

GAO found that: (1) choice of career paths in medicine is associated with the characteristics of students admitted to medical schools and with the curriculum and training opportunities they receive during their medical education; (2) the strongest predictor of whether students choose primary care careers is their stated preference for primary care before they enter medical school; (3) students who attend medical schools with family practice departments are more likely to pursue primary care medicine than those students attending schools without family practice departments; (4) once students graduate from medical school and enter residency programs, there is a significant association between program opportunities to expose residents to primary care faculty and the proportion of residents choosing generalist practice; (5) many medical schools do not require students to have primary care experiences before choosing residency programs; (6) financing mechanisms for residency training give greater incentives to training in nonprimary care-oriented settings than in primary care-oriented settings, which places primary care residency programs at a disadvantage because of their use of nonhospital settings for training; and (7) the Medicare payment methodology may need to be modified to provide incentives for training in nonhospital settings.

Matter for Congressional Consideration

  1. Status: Closed - Implemented

    Comments: No bills implementing this recommendation have been submitted in Congress.

    Matter: To support the training of primary care physicians, Congress may want to consider modifying Medicare's payment methodology for the direct costs of graduate medical education to provide incentives for training in nonhospital settings.


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