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Grassroots Mentorship

Indu Michael remembers the one-page medical field survey she filled out around this time last year. A pre-med student at the University of California at Los Angeles, she provided the correct job descriptions for surgeons, pediatricians, OB/GYNs, psychiatrists, and internal medicine physicians. Only one medical specialty stumped her.

“I had no idea what a hospitalist did,” says Michael, 21, a senior.

The anonymous survey was part of the application and interview process for the Undergraduate Preceptorship in Internal Medicine (UPIM), a program that was launched last summer at UCLA Medical Center. By the time Michael finished the three-week program in early September, she had a complete understanding of what hospitalists do. She also says she’s leaning toward an internal medicine (IM) career—and might become a hospitalist.

Figure (above): UCLA preceptorship participants: front row (left to right) Susan Shen, Indu Michael, and ZeNan Chang; back row (l-r) Hanna Liu, Stacey Yudin, Nasim Afsar-manesh, MD, Nazia Ashiq, and Urian Chang.

“I’m seriously thinking [Hem-Onc] may not be the direction I want to take,” Michael says. “I realized oncologists are mainly consultative doctors and it’s really the general medicine team that does the medicine.”

Those kind of comments are music to Nasim Afsar-manesh’s ear. Dr. Afsar-manesh, a hospitalist and assistant clinical professor at UCLA, developed the UPIM program from scratch as a way to expose pre-med undergrads to internal medicine. The ultimate goal, of course, is steering them toward an internist career. She is well aware of medical students’ declining interest in IM, and she believes outreach to undergrads and first-year medical students will help reverse the trend.

“Undergraduates are like sponges,” Dr. Afsar-manesh says. “They are so genuinely excited about the possibilities of getting to do this stuff. … You can appeal to their idealism.” She created the program because “the general field of medicine has become so complex that students who are thinking about making it a career don’t have a good chance to see what the day-to-day practicing of medicine is like.”

A Good Start, But Not Enough

It will take more than positive educational experiences to reverse the decrease in medical students choosing IM careers, Dr. Schwartz says. Studies have shown that while medical students consistently rate their IM clerkship high because they feel they’re practicing “real medicine,” they view IM careers as something of a Pandora’s box.

In a September 2008 article published in the Journal of the American Medical Association to which Dr. Schwartz contributed, it was reported that students perceived IM as requiring more paperwork and charting, and having more reimbursement and insurance requirements.1 Students also said they believe IM doctors have lower income potential, a demanding workload of sicker patients, less free time away from work, and a less satisfying family life.

“All these factors push students away from the field,” Dr. Schwartz says.

For IM to become a more attractive career option, he says three things have to happen:

  • The U.S. government has to get in the business of workforce planning as it pertains to primary healthcare, the foundation of which is IM;
  • The U.S. healthcare system has to begin increasing compensation to generalists and decreasing compensation to specialists by reforming the reimbursement system; and
  • IM doctors have to use available technology to redesign how they manage their patient load.

“Given the complexity of what doctors do, the days of doctors taking care of one patient at a time are numbered,” Dr. Schwartz says. “Doctors have to look at managing panels of patients who have similar health problems. We have the technology to do it, but we don’t have incentives lined up to promote that type of entrepreneurial spirit.”—LR

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