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MEDICAL
slot and shaves one year off of their medical school training. The
program also won a state primary care innovation grant from the
Texas Higher Education Coordinating Board.
National Resident Matching Program rules “require you to be all
in: If you are going to participate in the match, then all of your po-
sitions have to be in the match. The [Pathway] residency is probably
going to have to be bigger than what we can fill with local kids,”
Dr. Nash explained. The program likely could take advantage of one
or more of the GME expansion grants the legislature authorized to
promote and support such residency programs, “but there will have
to be other spots to comply with accreditation rules and also assure
these [Pathway] kids have a spot.”
Preceptorship Revived
The Statewide Primary Care Preceptorship Program meanwhile
has shown that mentorship and early exposure to primary care spe-
cialties have a positive influence on students’ decisions to go into
the field.
The program places first- and second-year medical students with
practicing internists, family physicians, and pediatricians across the
state to immerse them in one of these medical specialties for a sum-
mer. The medical students work in practicing physicians’ offices and
experience the daily life and work of participating mentor physicians
— known as preceptors — who provide direct experience and in-
sight into the clinical and administrative aspects of practicing pri-
mary care.
The statewide program cleared a major hurdle, winning back a
three-fold increase in funding after the legislature defunded it during
a 2011 budget crisis. Lawmakers put $3 million into the program
for 2016 and 2017, up from $904,000 the last time it was funded
in 2010–11.
Houston internist Robert E. Jackson, MD — one of more than
1,400 preceptors — says students get much more out of the money
than a summer stipend, as does Texas, which ranks among the bot-
tom states with the fewest number of primary care doctors serving
the population. He is a former governor of the Texas Chapter of the
American College of Physicians and a member of TMA’s Council
on Legislation.
“We are the front lines, and the legislature woke up and realized
how important it is to have enough primary care doctors, and that
you can’t just snap your fingers and become one,” said Dr. Jackson,
pointing to program data showing participants in the preceptorships
tend to choose primary care residencies at higher rates.
Over the past decade or so, the internal medicine and pediatric
preceptorships have shown that as many as 38 percent of partici-
pating students choose the specialty, compared with national res-
idency entry rates of 9 percent to 24 percent. The family practice
EDUCATION
preceptorship — the longest running of the three programs, since
1979 — has attracted as many as 28 percent of participating Texas
medical students to the specialty over the years versus 16 percent
of nonparticipants.
First-year medical students typically have not decided on a spe-
cialty, “and they have really not yet been exposed to that much
clinical medicine. What we as mentors try to demonstrate is the
joy of the practice of medicine and the breadth and depth of pri-
mary care,” Dr. Jackson said, likening the process to detective
work. “Patients — all kinds — come to me with a whole bunch
of complaints, and it’s so much fun to take care of them, plus it’s
an honor and privilege.”
That kind of enthusiasm rubbed off on Navy reservist John
DeMis. He knew he wanted to serve his country but, like most med-
ical students, wasn’t sure what kind of doctor he wanted to be when
he started at The University of Texas Health Science Center at San
Antonio. An internal medicine preceptorship gave him the answer.
“What really struck me was the relationships my mentor had built
with his patients. The bread and butter of primary care was made
more inspiring by seeing the compassion and empathy you share,”
Mr. DeMis said.
His preceptor was a career internist and nephrologist who, from
day one of the program, told the students they would be working
through lunch. It wasn’t long before Mr. DeMis figured out why:
Whether in the dialysis unit, hospital, or clinic, patients brought
homemade food and vegetables from their gardens.
“And now that I’m in my third year, I can’t overstate the impor-
tance of being able to constantly change gears from different settings.
It was so helpful to be exposed to that early on, and it made me bet-
ter in third year,” Mr. DeMis said.
Beyond the lessons on labs and charting, however, during those
car rides and long days, his mentor also imparted life lessons.
“When you spend this much time together, you don’t just talk
about medicine. We talked about things like having a family and
making enough money. And I thought, ‘Hey, I can do this,’” Mr.
DeMis said. “That was more useful than anything because so often
in medical school you’re learning curriculum and diseases and drugs.
But you don’t get to take a step back and see what your life is going
to be like. This program totally changed my outlook and made me
much more determined in my path to primary care.”
Amy Lynn Sorrel can be reached by phone at (800) 880-1300, ext.
1392, or (512) 370-1392; by fax at (512) 370-1629; or by email.
Amy Sorrel is the associate editor of Texas Medicine, a publication of
the Texas Medical Association. This article was first published in Texas
Medicine in March 2016.
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