Shifting Priorities in Medical School

It was interesting to read the Deutchman et al study regarding the shortage of primary care physicians, significantly linked to a low rate of medical students matching into primary care residency positions in the United States.1 The COVID-19 pandemic shifted medical student priorities from board exams to family and self-care, so this is likely to have had an impact.2 Medical students are notorious for their hard work ethic and competitiveness, which ultimately brings with it a high level of mental health illness. The highly academic nature of the course, and the constant reminder of professionalism and fitness to practice have contributed to many medical students not seeking valuable mental health support.3

I have some suggestions based on surveys of health workers during the pandemic. The major factors highlighted for distress were the loss of loved ones, the isolation from not being able to visit friends or family, and the fear of spreading the disease.4 There has already been widespread discussion about the inevitability of future pandemics. These are possibly why medical students who had initially been aiming for emergency or acute medicine might be leaning towards a specialty that allows working from home and not having to socially distance, such as family medicine or general practice. In the United Kingdom, there has been a mass shift to video and telephone consultations as a result of the pandemic, and general practitioners have found their workload more manageable and less stressful, being able to work from home and without putting themselves and families at risk.5 Although a larger proportion of family physicians in the United States work in nursing homes and family care practices, reduced anxiety levels for the more competitive subjects combined with a more family-oriented point of view is likely to have a significant impact on primary care career choices made by medical students. Furthermore, previous research has shown that students primarily decide their specialty based on being able to explore areas of interest, work experience, and letters of recommendation.2 Perhaps during this time, they will have ended up with a more community-based portfolio, and they will shift their sights to primary care.