What if you are really, really sure you want to do primary care, and you change your mind? What is the worst that can happen?
In order to be in the Primary Care Scholars Pathway, you sign a contract saying that you absolutely will go into a primary care specialty, currently defined as Family Medicine or Internal Medicine. That is the consideration that you are giving in exchange for the benefits of the pathway. You are affirming that you will complete an FM or IM residency and work as an attending primary care physician for the first 5 years after completing that residency. There are a couple of fellowships that you can do in between if you really want to, and you can certainly do some locums / moonlighting work as a hospitalist or EM doc during that time, as long as you fulfill your obligation to practice primary care as the main part of your professional practice throughout that time period.
In the worst case scenario, if you did commit to PCSP, with the *sincere* intent to go primary care all the way... and then realized along the way that you really wanted to specialize... you could pay LECOM the tuition that you skipped out on and go fulfill your heart's desire. You'd be no worse off than someone else who went for 4 years and followed the same course... indeed, you'd still be a year ahead of that person, and that means one more year of earning attending level salary in your chosen specialty. So, an honest change of heart doesn't really penalize you in the long run. If someone were intending to ruthlessly default on the agreement... well, there is really nothing stopping them from doing so and still benefiting from the 3 year program. Except the lack of integrity that it would display.
So, I would hate to see someone whose heart really is with primary care be turned away by overestimating the magnitude of the penalty for changing one's mind. What I would hope, what I would intend to do, if I somehow radically changed my mind, is to fulfill the commitment, work in primary care for the required five years, and then go back and do whatever fellowships or even additional residencies that would be needed to specialize at that point.
Is it even possible to change specialties after the first five years in practice? I think I want to primary care now, but I don't want to limit myself too early/get stuck in something that I don't want to do forever.
If after fulfilling the contract, a doctor did want to change specialties, that isn't off the table. I've met several physicians who were attendings when they decided that they wanted to go back and train some more to do something else. It isn't actually as hard to arrange as it sounds, and if you are smart about keeping your debt low, you have a lot more mobility in your career than you might imagine.
But the hope of all those involved in the Primary Care Scholars Program is that the student doctors who choose this pathway will be passionate about primary care... that, especially as they progress and see the enormous scope and opportunities available to primary care physicians, that they wouldn't dream of limiting themselves by selecting a different specialty.
That is certainly my feeling. Family Med docs can do procedures, surgeries, OB/Gyn, emergency, etc. No, they aren't going to be doing open heart, and the more urban the setting, the less likely they will be to get to do every single thing that is within their scope. But Family Med gives me the largest canvas for designing my own practice, to fill it with the particulars that matter most to me... while giving me the most opportunity to change my mind and do something different down the road, without having to change specialties. I am already planning my ideal clinic (
idealmedicalcare.org to read more about my inspiration, Dr. Wible,) and the plan doesn't include being beholden to corporations that have done so much to turn the art of medicine into a factory assembly line.
Commitments matter.
The success of the 3 year pathway and the possibility of more, similarly innovative programs opening up additional seats depends on having the students in the pathway live up to their side of the bargain. The pathway's purpose isn't to give just anyone a way to get through med school a year faster and cheaper... it is to produce more dedicated primary care doctors. Being one of those doctors who successfully completes the program makes the program itself more well-known, more effective in completing its goals. This is an important aspect of joining a profession... your behavior, your integrity, reflects on others. You are becoming part of something larger than you and your individual career, and that begins as early as matriculation. You begin to form a relationship with your school where your performance reflects on them, just as their reputation reflects upon you. Doing everything possible to improve the quality of that interrelationship, including fulfilling obligations and supporting fellow / future students, is simply enlightened self-interest.
I've heard that LECOM has a lot of really strict rules.
As with everything at LECOM... there aren't really any surprises. They tell you up front what is expected of you and what you can expect. But there always seem to be people who either didn't listen or didn't believe when they were told those things. It doesn't make sense to me to get too upset when the school does as it said it would do. Even when I've found myself called on the carpet for falling short of expectations, I have to admit that I'd been told in advance what those were and what consequences to expect for not meeting them. That is actually somewhat comforting.
LECOM has rules, and they enforce them fairly and consistently. It is actually a lot easier to work in an environment like this than in many settings I've been in where people in power play favorites and let some people bend rules more than others. That isn't to say that there is no mercy. Just that they treat you, from day one, like the professional that you are seeking to become, by expecting you to rise to the occasion.
