reWorking Michigan: Preparing Tomorrow's Primary Care Doctors

Jul 2, 2012

Last week’s historic Supreme Court decision upholding President Obama’s Affordable Care Act clears the way for some 32 million people to receive health insurance under Medicaid.  But many health experts fear there may not be enough doctors to serve everyone.  The nation is in the midst of a shortage of primary care physicians. 

In this week’s reWorking Michigan report, WKAR’s Kevin Lavery looks at how those who train tomorrow’s health care providers in mid-Michigan are getting ready for the influx of patients.

Ingham County Health Officer Renee Canady was all smiles Thursday as a press conference got underway at Union Missionary Baptist Church in Lansing.  The Supreme Court ruling on health care reform was barely three hours old -- and the euphoria was palpable.

Canady says the Affordable Care Act moves America towards what she calls a “culture of wellness.”  Under the law, millions of people who previously had no health insurance at all will be eligible for Medicaid.  That means more people will be able to see a doctor about their health issues well before their illnesses force a trip to the emergency room. 

Canady says the law raises the profile of preventive care.

“We want to get people connected to wellness opportunities so that we can prevent disease, and then teach our population, when is it appropriate to go to an emergency room, and when is it not?” Canady says.

But Canady’s enthusiasm is tempered by the economics of supply and demand.  There’s going to be a lot of patients -- but will there be enough doctors?

“I would not mince words on that,” says Canady.  “Absolutely, we have a primary care capacity concern in this region.”

In 2005, the Blue Ribbon Committee on Physician Workforce predicted that by 2020, Michigan would need an additional 4,400 doctors to adequately serve the population. 

The trend has been a clarion call for medical schools across the state.

“Well, we’ve been preparing for this," says Michigan State University College of Human Medicine dean Dr. Marsha Rappley.

About 200 students enter the school each year, and primary care is a cornerstone of its curriculum.  The college tracks its graduates 10 years after graduation, and Rappley says more than half her alumni have chosen to stay in primary care, and to stay in Michigan.

Rappley says national health care reforms offer an exciting opportunity to care for more people and in greater depth.  But Rappley admits it’s hard to teach would-be doctors how to interact with previously uninsured patients who until now have only sought medical help in an emergency room.

“It’s a special set of skills to work with people who are not used to being comfortable in the health system,” Rappley says.  “So, how do we help our young people learn skills that they need to change the attitudes of thousands of people around how to take care of themselves and how to take care of their families.”

Medical students considering careers in primary care also face financial challenges.  Dr. William Strampel is the dean of MSU’s College of Osteopathic Medicine.  He says the high cost of a medical education often prompts students who start out in primary care to turn to more lucrative specialties in order to pay off their loans.

“And we’ve got to figure out a better way of taking the pressure off the students that go into primary care,” Strampel says.  “Maybe there’s some loan forgiveness if they stay in family medicine.  All you’d have to do is do that, and you’d shift the  balance of people going into neurosurgery into...some would stay in family medicine.”

Like Rappley, Strampel has been building his curriculum over the years.  He says a decade ago, the MSU osteopathic program took on 150 students each year.  Since then, partially fueled by the state report on the growing physician shortage, the college has expanded in Lansing, Macomb County and Detroit.  Strampel says now, he receives 5,000 applications each year for just over 300 medical school slots.

Health care professionals say the Medicaid expansion translates into a more economically vital society.  Dr. Rappley says it will take some time for her team, hospitals and even patients to plan a larger health care strategy that shifts from urgent care to prevention.

“We all have to adjust now to this sort of a new normal,” Rappley says.  “But it’s going to be an interesting transition, and we’re ready for it.”


reWorking Michigan examines our evolving economy, as the people of the Great Lake State explore new ways to make a living and build a future for their families.  A project of WKAR Newsroom, WKAR-TV and