The medical education system suffers from a choke point that impedes efforts to increase the physician supply, so a handful of states have created financial incentives to lure practicing doctors to serve as mentors to students.
Too few physicians have been willing to oversee medical school rotations, limiting class sizes and the number of newly minted doctors entering the field. The unpaid nature of this work is one reason why.
Seven states have responded by establishing tax incentives worth up to $10,000 a year for physicians who take on the responsibility of helping train the next generation. These programs improve medical training and bolster the clinical pipeline, said Denise Kornegay, associate dean at Augusta University Medical College of Georgia and executive director of the Georgia Statewide Area Health Education Centers.
Kornegay led the charge to enact the nation's first tax incentive for precepting in the Peach State nine years ago. Colorado, Hawaii, Maryland, Missouri, Ohio and South Carolina have followed suit.
Since the Georgia program debuted in 2015, nearly 3,000 doctors have signed on, according to the Georgia Preceptor Tax Incentive Program. Many are from rural or low-income communities or operate independent practices, which is important for connecting students to pathways that fit their interests and long-term goals, said Dr. Erica Sutton, associate dean of academic programs at Morehouse School of Medicine in Atlanta.
"The outcome seen by students has been a greater diversity of exposure to different types of practice opportunities that they may want to have in their career," Sutton said.
How do state tax incentives compare?
In Georgia, participating doctors can receive a $1,000 tax credit per student, with a maximum annual incentive of $10,000. Colorado offers a $1,000 tax credit to doctors in rural communities. Maryland provides up to $10,000 a year to physicians in shortage areas. In Ohio, eligible federally qualified health centers can collect up to $50,000 annually for precepting students. In Missouri, family medicine, internal medicine, OB-GYN, pediatrics and psychiatry practitioners who sign up will be eligible for up to $3,000 a year when the law enacted last year takes effect.
Medical schools establish clinical training slots through partnerships with hospitals and affiliations with independent practitioners. However, recruiting enough doctors to serve as preceptors has been a barrier, Sutton said. Some physicians are uncomfortable taking on teaching roles, she said. Others struggle to afford it: Training medical students takes time and can cut into physicians' capacity to see patients.
Before the COVID-19 pandemic, 84% of medical school deans were concerned about the number of available clerkships for students, especially in primary care, according to survey results the Association of American Medical Colleges published in 2020. More recently, staffing shortages, burnout and economic headwinds have exacerbated the problem.
In Georgia, the competition is fierce among in-state and out-of-state medical schools for clinical training sites, Sutton said. As a result, most in-state medical schools could not expand class sizes in response to provider shortages due to a lack of training opportunities, Kornegay said.
"We have this burgeoning need in a very competitive marketplace," Kornegay said. "We needed to incentivize the preceptors to take Georgia students from Georgia programs."
Kiyana Harris, who will graduate from the Philadelphia College of Osteopathic Medicine in Suwanee, Georgia, later this month, said it's vital that medical schools increase the number of mentorship opportunities available, especially for minority students and those from disadvantaged backgrounds.
Harris, 30, grew up in public housing in New York City's South Bronx neighborhood, one of the most socially vulnerable communities in the nation. She always felt supported to pursue her dream of becoming a doctor, but lacked resources others possessed, Harris said. Many of the students against whom she was competing had doctors in their immediate families who guided them or they received professional help filling out applications.
"I don't have any doctors in my family, and no one ever told me, 'This is what you need to do if you're going to be a doctor,'" Harris said.
When Harris first attempted to get into medical school, every institution to which she applied rejected her. The same happened on her second try. Determined, Harris sought a master's degree and attended a medical mission trip to Belize, where she volunteered at a free clinic to make herself a more appealing candidate. She also worked full-time to cover living expenses and save up for costly application fees. When Harris applied to medical schools for a third time, she held her breath.
In July, Harris will begin a psychiatric residency program at Morehouse School of Medicine, where she hopes to focus on racial disparities in mental health. Her journey through medical school was turbulent, she said. Harris had to take on significant amounts of debt, and she felt behind her peers, who all seemed to have previous exposure to the medical field. In contrast, her memories of the healthcare system feature bus rides to Manhattan when she was sick and scary trips to the hospital when her mother fell severely ill.
Medical schools could better support people like her—a Black woman who grew up poor—by creating opportunities to help them adapt, Harris said. "We need mentorship and people that are in places that you want to be because there was no one that looked like me that was a doctor. I really didn't have anybody to talk to about these things," she said.
A doctor's perspective
Dr. Samuel Church, a family physician in rural Hiawassee, Georgia, has trained medical students for more than 15 years. Until recently, he did it for free. "The amount of teaching I do doesn't make sense from a business perspective, but we've got to educate these students," he said.
Church typically oversees one student per six-week rotation. While the credit doesn't cover all costs, it makes it more feasible, he said.
"There are a lot of practices and really great doctors and mentors who just can't afford the slowdown that students bring to the table," Church said. "The tax credit does not make up for all of that, and the list of intangibles that come along with teaching is long, but the tax credit just removes one of those barriers."
Dr. Joseph Flaherty, president of Western Atlantic University in the Bahamas and the former admissions dean at the University of Illinois School of Medicine in Chicago, said state tax credits are welcome, but warned such incentives could dilute the learning environment if doctors take on more students per rotation. The best training environments typically have two students per doctor, he said.
Since Georgia enacted the tax credit, physicians who had previously mentored two students per rotation are now taking on four or five, Kornegay said. The credit is attracting new physicians into the preceptor network, too. More than 200 registered to train students last year alone, she said.
"That is pretty astronomical," Kornegay said.