Pitt launched its three-year MD program in the 2023-24 academic year.

Studies show optimal health outcomes in populations where 40% of the physician workforce practices primary care, yet only about 33% of American physicians do.

The dearth of primary care physicians in the United States is well documented. For decades, the number of new doctors training in primary care relative to specialty care has been declining. Then, COVID-19 walloped the primary care system, exhausting and further whittling away its workforce.

“It’s already happening, but we are going to be short PCPs in the next 20 to 40 years,” says Amanda Casagrande, an MD practicing family medicine in Pittsburgh who’s an assistant professor of family medicine at the University of Pittsburgh. A quarter of today’s primary care physicians are expected to retire in the next decade.

Fewer doctors, says Casagrande, “means more patients for us [existing PCPs]. We always feel the crunch.”

In response to the mounting need, this academic year Pitt Med launched the Primary Care Accelerated Track (PCAT), a three-year path to an MD degree. Casagrande directs the program, which is a partnership between the School of Medicine and UPMC Medical Education (the residency and fellowship programs).

The goal of PCAT is to attract outstanding future physicians to pursue careers in primary care specialties, particularly in Western Pennsylvania, ultimately improving quality and access to care in the region.

Students who successfully complete the PCAT requirements have preferred entry into (i.e., “are ranked favorably” by) the UPMC residency program of their choice: family medicine at UPMC St. Margaret, UPMC Shadyside and UPMC McKeesport; internal medicine at UPMC Montefiore; or, starting next year, pediatrics at UPMC Children’s Hospital of Pittsburgh.

Earning the MD in three years also means 25% less tuition than a four-year program, a welcome prospect to anyone facing a mountain of student loans, which is most medical students.

That’s especially important for recruiting new MDs into primary care careers, which don’t have starting salaries or earning potential as high as other medical specialties.

“I’m ready to kind of get my life on the road, so I’m happy that [PCAT] helps on that front,” says Caleb Jones, a nontraditional student at age 28 and one of three students in the program’s first-year cohort.

Jones applied to Pitt Med after doing an AmeriCorps City Year program, teaching microbiology as an adjunct after earning a master’s in biology from American University and working for a year at an ophthalmology clinic near Washington, D.C. Another year doing bacteriophage therapeutics research made him miss the clinic. In retrospect, he sees how each step in his journey has pointed him here, to becoming a primary care doctor.

“The accelerated track is really for students who know what they want to do,” says Casagrande, something she admits can be challenging.

For Amrita Mani, a North Carolina native and PCAT student straight out of undergrad, “it definitely took a lot of conversations—” not just with PCPs but with other docs—to realize what type of doctor she might become. (PCAT also encourages broader exploration and shadowing opportunities in nonprimary care specialties.) It was while working at a free community health clinic in Durham that the psychology major’s many interests coalesced into a career Mani could imagine for herself.

“I loved seeing how resourceful the doctors and nurses there had to be.” She enjoyed working with medical translators for non-English-speaking patients and developed a deep appreciation for doctor-patient relationship building as fundamental to good health care.

Training grounds

First-year PCAT students spend a half day every other week at their residency site of interest. Jones is at UPMC McKeesport.

The day after his clinic, his four-year peers often ask him what he saw. “I’ll give a HIPAA-friendly version. But it’s always striking how relevant it is to what we’re learning,” he says.

“One of [the residents] said that having me around was an interesting addition. They think in terms of orders and the running of the clinic and the very outward appearance of these diseases. But I’m still thinking very much in terms of the hormones and the proteins and the muscles. It was encouraging to hear him say it was a good reminder to them all, of where they started.”

At her UPMC Shadyside clinical placement, Mani works with a program for expectant mothers at the same stage in their pregnancy.

“They take classes and workshops together, and when they give birth, their babies become patients at Shadyside.” Family medicine in action.

Casagrande worked with associate dean for medical education Jason Rosenstock, an MD (Res ’96), and the committee overseeing the new Three Rivers Curriculum to make sure that PCAT students would be integrated with the rest of their class when both programs launched in the fall.

To earn the MD in three years, PCAT students make the most of their summers. One month before the traditional term starts, PCAT first-years take a course on community health, clinical skills and health care systems. They explore the county health department and free clinics in surrounding communities.

In July 2023, Mani, Jones and Aaron Chacko, the third student in the accelerated program, spent their first week at the Pitt Vaccination and Health Connection Hub on the Pittsburgh campus.

The Hub (for short), born out of the urgency for equitable COVID-19 vaccine distribution in the early days of the pandemic, quickly became a hands-on classroom for Pitt students across the health sciences. The Hub teaches about all aspects of running a vaccination clinic, from billing to bedside manner. Casagrande serves as one of the Hub’s medical directors.

Her second day there, Mani learned that nearly 90% of Americans live within five miles of a community pharmacy. That insight offered food for thought: What if more aspects of patient care were provided in pharmacies, which would increase access to care in underserved areas? Nonphysician health professionals and doctors alike already share some administrative and basic care duties.

Yet, pharmacists are also overtaxed these days—another community provider shortage. At the same time, the American Medical Association has been pushing back against what it considers “scope [of practice] creep.”

Something needs to budge. An October 2023 analysis by the federal Bureau of Health Workforce projects that nonmetro areas of the country will see a nearly 56% shortage of physicians (across all specialties), compared to a 6% shortage in metro areas by 2036.

At the Hub, says Mani, “We talked a lot about the various restrictions that different states have on what the different health care professionals can do.”

She’s already seeing potential for redressing health inequities.

“Changing those laws to give more allowances,” she believes, could help close the gap.

A full spectrum of care

PCPs treat the broadest range of conditions and illnesses among the physician specialties—acute and chronic, physical and psychological. You can see your PCP for a rash, fever, strep test, Pap smear, skin biopsy, to deliver your baby or to maintain your cholesterol.

“From a health care equity standpoint,” Casagrande says, “we are the touchpoint to the health care system for patients.” She thinks of primary care physicians as the quarterback of the care team, coordinating, breaking it all down and making sure the patient understands what’s going on.

Chacko embraces this role: As a PCP in training, he says, “I am someone who sees not just the disease but a person as a whole.

“I hope to form long-term relationships such that I can be an advocate and someone who is focused on preventing disease rather than only fixating on the cures.”

It is widely accepted that PCPs can help save the system money, says Casagrande. “I think more health systems are starting to recognize this benefit; but saving money still isn’t the same as making money, and a lot of what we are able or unable to do in health care is unfortunately related to money.” 

Casagrande welcomes this top 10 in National Institutes of Health–funded research institution doubling down on its investment to develop committed PCPs. Pitt is not the first to offer a three-year MD. More than 30 other medical schools in North America have developed three-year programs since 2015.

Chacko was attracted to Pitt Med’s PCAT from New Jersey because of the collaborative atmosphere. “I was enthusiastic about the small, case-based learning groups and the abundance of opportunities to interact with patients within the curriculum.”

PCAT emphasizes that students can always change their minds. They can drop out of the accelerated track at any time and are not required to go to any UPMC residency program nor to pursue primary care if their goals change. Although, Casagrande says, “we hope as residents that they’ll really hit the ground running because they’ll already know all the faculty members and be integrated into their hospitals.”

As the program grows, Casagrande would like to recruit more students from the area. A Pittsburgh native herself, she believes “there’s just something about people from the city training to become doctors here and staying to take care of the community.”

Wherever PCAT students come from, “We expect they’ll be great communicators, educators, leaders, health systems scientists and advocates for social justice. I hope that med students, if exposed to primary care early, will understand the full spectrum of what we can really do.”   

To apply to the PCAT program, go to www.medschool.pitt.edu/admissions

Read more from the Winter 2024 issue.