Primary care group urges continued state funding for primary care preceptorships

posted 10.14.10

The Primary Care Coalition, a partnership comprised of the Texas Academy of Family Physicians, the Texas Pediatric Society, and the Texas Chapter of the American College of Physicians, has released its first one-page advocacy brief asking the Texas Legislature to maintain funding for the Texas Statewide Preceptorship Program and continue building this program in the future.

TSPP provides funding to first- and second-year medical students to spend up to four weeks in a primary care physician’s office experiencing the daily life and work of doctors in the specialties of family medicine, general internal medicine, or general pediatrics. Many of these pre-clinical students have never experienced medicine outside of the academic setting, and focus on basic clinical skills.

More importantly, medical students receive exposure to primary care early in their medical school careers and many leave the program with a higher regard for the specialties. As the issue brief highlights through cited studies and exit surveys, increasing student interest in primary care and subsequent specialty choice can make a big difference on the dearth of primary care physicians in the state. Combined, the three programs have placed more than 6,000 medical students in primary care clinics for four-week internships since 1995.

A comprehensive study covering nine years of Texas medical school graduates showed that students who participated in a family medicine preceptorship were almost twice as likely to pursue a career in family medicine as those who didn’t complete a preceptorship. And, of the 238 medical students who completed family medicine preceptorships in 2009, 93 percent said the experience made them more receptive to primary care as a career.

Surveys from general internal medicine and pediatrics show similar findings. From 1999 to 2006, more than 1,400 medical students completed a general internal medicine preceptorship, and 40.6 percent of them enrolled in an internal medicine residency program, 26.4 percent of them intended to practice primary care, and 82 percent of them intended to stay in Texas. From 1999 to 2009, almost 1,400 medical students completed a pediatric preceptorship; 37 percent of them entered a pediatric residency, and 62 percent stayed in Texas.

Funding depends on the will of the Texas Legislature, which provides an appropriation to the Texas Higher Education Coordinating Board, and budget reductions over the past decade have put a noticeable dent in student participation. The most damaging cut to the preceptorship programs came during the 79th Texas Legislature in 2003. The program’s budget was cut in half from $1.94 million in fiscal years 2002-2003 to $997,000 in 2004-2005, and accordingly, the number of students participating in the preceptorships plummeted from just over 800 in fiscal 2003 to roughly 500 in fiscal 2004.

As lawmakers face a similar scenario in the 82nd Session as they did in the 79th Session, the Primary Care Coalition asks the Legislature to restore funding for the Texas Primary Care Preceptorship Programs to 2002-2003 levels: “$1 million a year is a tiny fraction of the state budget, but it could make a tremendous difference to the foundation of the state’s health care delivery system.”

This issue brief is the first of many the group will release before and during the 82nd Texas Legislative Session to educate lawmakers on issues important to the primary care physicians of Texas. To read the full brief, go to the Advocacy Resources section of TAFP’s website. Also watch for a feature on this issue to be published in the fall edition of Texas Family Physician magazine.