Community College Pathways to Medical School and Family Medicine Residency Training

In "Community College Pathways to Medical School and Family Medicine Residency Training", Talamantes et al make the assertion that Community College is a pathway that can be used to promote primary care, specifically family medicine. While community college can certainly be used as a bridge to primary care, there are three factors of significance have been excluded from this study which limit the authors' ability to assert that community college attendance can ameliorate the primary care physician shortage. These factors include the influence of medical school experiences on specialty choice, the impact which Osteopathic and International Medical Graduates have in expanding the primary care workforce, and the Affordable Care Act's (ACA) effect on increasing primary care demand.

Many individuals arrive to medical school with a preconceived notion of what type of physician they would like to become. A number of events, however, take place after acceptance to medical school which affect the specialty an individual chooses. These events include United States Medical Licensing Exam (USMLE) scores, student interest group involvement, third and fourth year clinical rotations, and mentor advice. A study conducted by Julie Phillips, MD, MPH and Iain Charnley, MD demonstrated that third year and fourth year rotation exposure to family medicine positively influenced attitudes toward primary care.[1] A second limitation is that this study excludes both osteopathic (DO) students and International Medical Graduates (IMG).[2] According to 2018 NRMP data, while there were 18,818 allopathic graduates, the DO and IMG applications collectively equaled 9692 applicants, which is a significant number excluded from this study.[3] Approximately 32% of IMGs involved in graduate medical education are in family medicine.[2] A third limitation is that The ACA was signed into law in 2010. This act increased primary care compensation, which is reflected in trends in family medicine salaries since that time.[4] According to the 2018 NRMP, there is a larger influx of residents going into primary care which is likely multifactorial, including increasing loan repayment incentives, signing bonuses, and salary compensation.[2]

This article presents an intriguing point recognizing that some students from underrepresented minorities and low socio-economic status (SES) are more likely to attend community college. Certainly, community college can serve as a pipeline to primary care specialties. However, attention should also be directed toward circumstances during medical school which impact students' viewpoints of primary care. Future studies should describe how medical school experiences may influence specialty choice, include pre-med experiences of osteopathic and IMG physicians, and account for national and systemic influences on specialty choice.

1) Phillips J, Charnley I. Third- and Fourth-Year Medical Students' Changing Views of Family Medicine. Fam Med. 2016 Jan;48(1):54-60.
2) Ahmed AA, Hwang WT, Thomas CR Jr, Deville C Jr. International Medical Graduates in the US Physician Workforce and Graduate Medical Education: Current and Historical Trends. J Grad Med Educ. 2018 Apr;10(2):214-218
3) NRMP homepage. http://www.nrmp.org/ Retrieved on July 31, 2018
4) http://www.physicianspractice.com/. Retrieved on July 31, 2018.

Competing interests: None declared