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Article by Somdatta Basu
Addressing the Primary Care Crisis: Insights from Dr. Steven Spann
May 25, Houston (TX): On the IACCGH Business Hour, Dr. Steven Spann, founding dean of the Tilman J. Fertitta Family College of Medicine at the University of Houston, emphasized the urgent need for more primary care physicians in the U.S., projecting a 30% increase in demand by 2030. He highlighted the root causes and potential solutions to this crisis, emphasizing the need for better primary care despite the U.S. having top-notch medical facilities and innovations.
Dr. Spann’s journey in medicine began at Baylor College of Medicine at 24. Initially training in internal medicine, he discovered his passion for family medicine while serving in the National Health Service Corps in rural Arkansas. This led him to complete his residency at Duke University Medical Center and practice in rural North Carolina, providing comprehensive care. His career spans esteemed institutions, culminating in his current role at the University of Houston.
The new medical school at the University of Houston, which opened four years ago, marked a significant milestone by graduating its first batch of students this year. The school’s mission is to train physicians who will serve the state, particularly in primary care or other needed specialties. With 83 million Americans lacking adequate access to primary care, the school’s focus is strategic. Dr. Spann emphasized the importance of well-trained family practice doctors, particularly in underserved areas.
Addressing the primary care shortage, Dr. Spann pointed to medical school culture and financial incentives as significant factors. Many medical school faculty are specialists, and students often follow their mentors. Additionally, the compensation gap between primary care physicians and specialists, especially those performing procedures, deters students from choosing primary care. The University of Houston’s medical school tackles these challenges by including early exposure to primary care in the curriculum and admitting students with characteristics predictive of choosing primary care. The school’s diverse student population, with many from first-generation college families and underserved communities, reflects this commitment.
Optimism about the future remains strong. “57% of our first graduates matched in residencies in family medicine, internal medicine, or pediatrics,” Dr. Spann shared. While not all will pursue primary care, the foundation is being laid for a new generation of physicians dedicated to serving the community.
Dr. Spann acknowledged the significant financial burden faced by medical students, often graduating with over $200,000 in debt. This debt influences their career choices, pushing them toward higher-paying specialties rather than primary care. While state and federal subsidies exist, more support is needed. Texas provides substantial support to its state medical schools, keeping tuition relatively low compared to other states. Some private institutions, like Baylor College of Medicine, also benefit from state funding, making their tuition comparable to state-supported schools.
Philanthropy plays a crucial role in supporting medical schools, with contributions from individuals like Tilman Fertitta and Dr. Durga Agarwal. The college’s mission to train more primary care physicians is evident, with 57% of graduates choosing residencies in primary care, reflecting the school’s commitment to addressing the shortage.
Dr. Spann passionately discussed compassionate care in medicine, citing the book “Compassionomics,” which presents evidence that empathetic relationships between healthcare professionals and patients lead to better health outcomes, higher patient satisfaction, lower costs, and reduced burnout among providers.
Recent data revealed a startling 19.3-year difference in life expectancy between the wealthiest ZIP code in the city and the least healthy ZIP code nearby. This disparity highlights severe health inequities. Dr. Spann explained that wealthy countries spend a significant portion of their GDP on both healthcare and social care, addressing adverse social determinants of health. The U.S. is an outlier, leading in healthcare spending but lagging in social care. When combined, overall spending is among the highest, yet the U.S. has the lowest life expectancy among wealthy nations.
The dean of UH Medical College advocated for fundamental changes, such as providing free healthcare throughout pregnancy and the first year of a child’s life, which could drastically improve life expectancy and health outcomes.
Drawing comparisons to other countries, Dr. Spann pointed to the United Arab Emirates, where universal health coverage and strong primary care systems are in place. He said, “Everyone, including low-income workers, has insurance. They emphasize prevention and access to family doctors, which makes a significant difference.” The Tilman J. Fertitta Family College of Medicine at the University of Houston aims to address these disparities by training a new generation of doctors focused on primary care and serving underserved communities.
Reflecting on the broader healthcare system, Dr. Spann noted that the U.S. had some of the best sick care in the world, but it didn’t reach everyone.
As the city grappled with profound health disparities, the insights and initiatives of leaders like Dr. Spann offered a path forward.