Filling the primary care gap

Pioneering ACE-PC partnership offers faster pathway to M.D.

America is expected to face a shortage of 45,000 primary care physicians by the end of the decade. The deficit may be especially pronounced in California, thanks to existing shortages, the nation’s largest percentage of primary care physicians nearing retirement, and a greater prevalence of rural, inner-urban and fast-growing communities.

Pile on the increased demand created by health care reform, and the need for generalist physicians may be as great as ever.

To help narrow the gap, UC Davis and Kaiser Permanente Northern California teamed in 2014 to launch one of the nation’s first three-year medical school programs, the Accelerated Competency-based Education in Primary Care program or ACE-PC at UC Davis School of Medicine.

ACE-PC students complete the same pre-clerkship requirements and clerkship rotations as students in the traditional four-year track, but they enter practice earlier – and with less of the debt that burdens new physicians in the lower-earning primary care professions.

“The whole thing is harder, but our expectation is that students will perform as well, if not better, than students in the traditional pathway,” said Tonya Fancher, a UC Davis associate professor of internal medicine who is the program’s founding director and principal investigator for the American Medical Association grant that helped launch it. “We haven’t changed expectations, the learning just happens in a different way.”

Participants forego summer breaks and also launch into clinical clerkships at Kaiser facilities within a week of starting med school. Clerkships are longitudinal to cultivate patient-centeredness. Students also digest unique content on population management, quality improvement, team-based care and preventive health.

Up to six students enroll per year and the program currently has 12 students. All have experience in community health, more than half have fluency in a second language, and many are the first in their families to attend college. Program leaders hope to expand the cohort size and also branch into shortage areas such as psychiatry and pediatrics.

“ACE-PC addresses a major deficiency in American medical education, namely the identification, mentoring, and financial support of students who know they want to be primary care physicians,” said John Chuck, a Kaiser physician and UC Davis School of Medicine Alumni Association board member who helped plan and launch the program, and remains involved as a coach for students. “I’m especially proud of the collaborative nature of this dynamic experiment, which stands out in my mind as a crown jewel of the longstanding partnership between UC Davis and The Permanente Medical Group.”