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For more than two decades, the University of Washington School of Medicine has offered a monthlong elective that sends second-year students to underserved and rural areas to deliver primary care. In today’s New York Times, Kevin Sack delivers a sobering report on how the experience impacted students who participated in the elective this summer.

To sum up: the experience acted as a disincentive to students contemplating the primary care path.  They returned to med school with “their idealism tempered,” the belief that rationing of health care is inevitable, and serious frustration over primary care payment policies that drive providers into grueling hours and then early retirement.

The students’ disillusionment is upsetting, particularly because they were following a preexisting interest in working with the underserved — an interest that now seems to be extinguished instead of magnified as a result of their time in the trenches.

But even more upsetting than individual disillusionment is what precipitated it: a system of health care delivery in which “to make a living, and chip away at immense educational debt, general practitioners often find they must churn patients and work long, unsatisfying hours” — and in which “‘you know the patient, you know the patient’s financial information, and then you make clinical decisions based on that.’” 

Providing primary care, especially to underserved communities, is hard. Sticking with it is even harder. At ASF, we don’t shy away from that fact. In fact, the primary purpose of our Fellows for Life network is to enable program alumni to support each other in the often-exhausting paths they’ve committed to. And a signifier of the Fellowship’s year-long direct service project is that in carrying those projects from concept to completion on top of their preexisting professional school responsibilities, Schweitzer Fellows come away with a hard-earned blueprint for how to consistently integrate working with the underserved into their lives.

That blueprint is made even more difficult to adhere to by a health care system that disincentivizes primary care. But perhaps that will change (see President Obama’s previous call for more support of primary care doctors  — hopefully in tonight’s speech it will be substantively expanded upon).

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