The slow-motion train wreck that is primary care has been brewing for a couple of decades: medical students opting for higher-paid specialties than primary care whereas the primary care physician workforce is aging and retiring faster before they are being replaced. Stir in physicians’ dissatisfaction with short visits and unrealistic productivity expectations and you end up with a specialty that, though fundamental to health care and people’s health, is on life support. The COVID-19 pandemic accelerated all of this to where we are facing an existential crisis for primary care and general internal medicine.
It is not that primary care is not wanted or needed. All patients want “their doctor,” someone they can go to for new problems and worries and who will care for them and their chronic maladies, mitigate their risk factors, and help them navigate our labyrinthine healthcare system. And yes, to hold their hands and ease their passing. What to do? Assuming dramatic increases in primary care physicians’ salaries is not in the offing, we need new models of care that include not only physicians but also nurse practitioners, physicians, assistants, nurses and nurse educators, mental health counselors, social workers, and community health workers, each working at the top of their capabilities. Who will develop, test, revise, retest, and deploy such models of care? Patients, clinicians, and health care managers all need to be engaged, led by SGIM and its members.
It is critical that SGIM does more than survive as an organization that supports the professional development of its members. It needs to grow to attract and support health services researchers and clinician leaders who will create and assess these new models of primary care; demonstrate their value to patients, clinicians, health care administrators, and payers; and implement them in their own primary care health systems.
I talk to medical students regularly, and they give me hope. Although they know our health system is unwell and physicians are stressed, they are working hard to become physicians because they know that they can make a difference to their patients and to the health systems that care for them. We need these people to join us in our efforts to recreate primary care!
SGIM can and should attract young physicians to academic careers to revolutionize primary care. One way is to help them attend SGIM’s annual meeting. Time and again, I hear of students who have attended our meetings and come away both awed and inspired by the work being done. We should feel obligated to encourage our students, residents, and fellows to attend our meetings and strongly consider careers in academic general internal medicine. And we should do what we can to lower the barriers to their engaging with us.
A significant barrier to trainees’ engaging in SGIM and its meetings is financial: dues and meeting fees are not cheap. SGIM’s annual meetings are well-attended, given its relatively small size, and there is a huge, broad panoply of offerings in each of the missions of primary care, teaching, and research. Meeting fees are substantial because the meeting is substantial. SGIM itself is a broad organization that supports 15 committees, 4 commissions, 72 interest groups, 6 work groups, and 7 regional meetings. Managing all of this requires a staff of 21 and substantial annual dues.
SGIM’s dues and meeting fees are sufficient to “keep the lights on.” But, especially for students, residents, and fellows, we can and should do more. And we are. Through generous donations to SGIM programs, such as Forging Our Future, SGIM has been able to pay 2022-23 membership dues for 75 first-year fellows, provide scholarships for 50 students and residents to attend the 2023 annual meeting, and support 110 one-on-one mentor pairs and 23 junior faculty in its Women in Medicine Commission’s Career Advising Program. Donations to SGIM’s Unified Leadership Training in Diversity Program (UNLTD) has allowed it to expand, increasing the number of junior faculty participating and enriching the program’s content. SGIM has hired an innovative consulting group to help the Association of Chiefs and Leaders in GIM (ACLGIM) develop and implement novel approaches to recruit and retain trainees and young physicians into GIM. SGIM has also launched GIMLearn, a platform through which young GIM educators can store, share, and disseminate innovative approaches to teaching. It received 30 programs to its first call for submissions, 12 of which have been accepted already.
Most of the funds supporting these programs come from substantial donations from a small number of SGIM members: only 6% of SGIM’s approximately 3,000 members were donors in 2022-23. Just imagine what an expanding “Spirit of Philanthropy” could do within SGIM! If each member donated $25 or more annually, the resulting $75,000+ would provide much greater sustained support for trainees and junior faculty, exposing them to the wonders of our field and the spirit and culture of SGIM, our specialty’s academic home. More would join us and be the vanguard of a new generation of health system innovators. SGIM members have always given freely of their time, talents, and treasures to trainees; we encourage each member to donate an amount they can afford to ensure the future of GIM.
As the end of the year draws near and Giving Tuesday looms, please consider adding SGIM to your philanthropy plans. This year SGIM’s goal for Giving Tuesday is to cover the cost of at least 10 additional scholarships allowing students and residents to attend SGIM’s 2024 annual meeting. You can help us reach our $5,000 goal and ensure an additional 10 or more trainees are able to benefit from the career-changing experience of attending SGIM’s annual meeting by visiting the donation page on SGIM’s website to make your gift today.1
Primary care and caring for people in need is the most rewarding and satisfying career in medicine. But the care needs to be delivered by the right clinicians in the right venues at the right time for the right people for our health system to be both efficient and effective. I encourage all SGIM members to join in the Spirit of Philanthropy and make a modest donation annually to SGIM so it can attract the young academic physicians and help them create the new models of primary care we so desperately need.