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UNE medical students at LRGH hesitate to enter primary care under weight of debt

Matt Libman, of Pelham, a third-year medical student on rotation at the Lakes Region General Hospital in Laconia, checks over Norton Bogley, of Plymouth, during a visit on Thursday morning, September 12, 2013. Libman is one of several third-year students on rotation at the Laconia hospital from University of New England College of Osteopathic Medicine, in Maine.

(JOHN TULLY / Monitor staff)

Matt Libman, of Pelham, a third-year medical student on rotation at the Lakes Region General Hospital in Laconia, checks over Norton Bogley, of Plymouth, during a visit on Thursday morning, September 12, 2013. Libman is one of several third-year students on rotation at the Laconia hospital from University of New England College of Osteopathic Medicine, in Maine. (JOHN TULLY / Monitor staff)

Eugenia Edmonds is reluctant to let go of her romantic notion of a country doctor, though it sometimes seems that the world is determined to disillusion her.

“I’m definitely interested in the primary care aspects of having a long-term relationship with patients,” said Edmonds, a student spending her third year of medical school at Lakes Region General Hospital. “I’ve just always believed that the more you know about a patient’s lifestyle and history, the longer you’ve had that relationship, the more you can help them be healthy.”

But “I’ve met docs who are still trying to pay off their student loans, and they’re 50. They’re still struggling because every Medicare patient they see costs them money. It’s discouraging,” she said.

Edmonds, who is from Brooklyn, and the other seven students at Lakes Region this year attend the University of New England College of Osteopathic Medicine. The Monitor spoke with six of them a few weeks after they arrived in Laconia, to learn their thoughts, hopes and concerns about a career in primary care – a career in which their school specializes and a choice they will make as America faces a shortage of primary care doctors.

Though several of the students are attracted to primary care, no one is ready to say it’s what they will do, for reasons that reflect why this is an issue nationwide. They have until the end of this school year to decide which specialty they want to pursue, because during their fourth year of medical school, they will spend a lot of time visiting hospital residency

programs and interviewing for spots in their chosen specialty.

Primary care physicians

Edmonds isn’t the only one of the group attracted to primary care – which is defined as family medicine, general internal medicine and pediatrics – and that’s not surprising, since osteopathic medical colleges tend to send more graduates into primary care than other medical schools.

Osteopathic medical schools focus on preparing physicians for primary and preventive care. Osteopathic physicians receive extra training in the musculoskeletal system – the body’s system of nerves, muscles and bones – to understand better how an illness or injury in one part of the body can affect other parts. Osteopathic physicians represent about 6.5 percent of doctors in the United States, according to the American Osteopathic Association.

In 2009, 47 percent of UNE osteopathic medical school graduates went into primary care residencies. Nationally, the average this spring for medical colleges was 5.4 percent.

“There is a need for primary care physicians, and our school in particular is proud that we provide a lot of them,” said medical student Shannon Alexa of Colorado Springs, Colo.

‘Like we bought a house’

By “being a rural care family doc,” one career she’s envisioned for herself, Alexa said, “you’re there to watch these people grow up and develop. It’s really rewarding. But I have to take into account sitting there with these interest statements every month going, ‘Gee, how am I going to pay these back?’ ”

The students each seek between $60,000 and $80,000 in loans and grants annually for their medical education, and some said they are still paying back loans from their undergraduate education.

Hayley McHugh of Concord, Mass., said she’d love to practice general pediatrics in rural Maine, however, she may not have much of a choice. The country’s largest loan repayment program for doctors is the National Health Services Corps, which dictates where doctors will practice based on the areas of greatest need. McHugh would more likely be assigned to a rural area in the West than to Maine, she said.

If she tried to practice primary care in Maine without joining the corps, McHugh said she would likely have to work for a hospital or a doctor group to ensure her economic stability.

Living with medical school debt is “like we bought a house and we have a mortgage on it,” she said. “It just makes things like actually buying a house, or just being a real person after you graduate, that much harder.”

Pursuing subspecialties

And primary care just isn’t for everyone.

Matthew Libman, a Pelham native, is equally interested in neurology and pediatrics. Emily Allex of St. Cloud, Minn., thinks she might want to be a surgeon. The desire to pursue subspecialties that interest them often pulls medical students away from family practice, the most general of the three primary care specialties, they said.

“If you go into internal medicine, you can still specialize in cardiology. You see cardiology patients that feed your interest, but then also have a base of primary care patients and see more conditions and do that work, too,” McHugh said.

Nick Gallagher of Maine said he’s drawn to emergency medicine for a lot of reasons, but among them, there’s the fact that he wouldn’t have to run the administrative side of the business.

“In the ER, you get a salary, you treat patients, and you don’t have to worry about whether they have insurance,” he said. “You give up the freedom of running your own shop, but you gain the freedom to practice medicine without worrying if you’re financially secure.”

‘Follow their passion’

For doctors on the other side of the big decision, who have already chosen a specialty, the fear of paying back their loans wasn’t enough to keep them out of an area of medicine they liked, according to a study released this spring. More than 98 percent of residents said they chose their specialty based on which they felt fit their personality best. Almost as many said they made their choice because they’re interested in the type of work they would do in the specialty.

Finding that fit, the passion for a specific branch, is the best way forward for medical students, said Travis Harker, the president of the New Hampshire Medical Society and a family physician at the Concord Family Health Center.

“Physicians have a high degree of burnout. The work we do is hard, people are sick and the hours are long. That’s why it’s so important that people follow their passion in medicine,” he said.

“I don’t know any doctor who is struggling financially when you put it in the context of the larger society. . . . I know physicians who aren’t happy in their specialty, whether it’s cardiology or surgery or anything; they’re not happy in their work, and they’re biding their time until they have enough money to retire,” he said.

“I would tell students to continue to follow the spirit that brought you into medical school in the first place.”

The students emphasized that for now, they have only a vague picture of what they want from their future careers. They finished their first of eight rotations last week, so there are seven more specialties for them to delve into and learn about.

Edmonds, who was so sure she wanted to hang out her shingle as a primary care doctor in a small town, spent her first rotation in surgery.

“I love it,” she said, sounding surprised. “I just don’t know yet where I’m going to be when I come out of this.”

(Sarah Palermo can be reached at 369-3322 or or on Twitter @SPalermoNews.)

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