The Community Preceptor Crisis: A Call to Action

What happens if there are not enough practicing community pediatricians or enough time in the day for community pediatricians to instruct medical students or residents? How will we highlight the necessity of caring for children in the community and train the community pediatricians of the future? From the time burden of providing quality education to the often limited resources in helping to provide that education to medical students and pediatric residents, the future pediatric workforce is in jeopardy if we do not address the community preceptor shortage that has been building for decades. The American Academy of Pediatrics (AAP) believes that the current pediatric workforce is not meeting the primary care needs to provide quality health care for children in the United States and that critical workforce shortages exist in pediatric care.1 Although the increased fill rate of medical students matching into categorical pediatric residency programs for 2025 is promising, with the decline of the fill rate of medical students matching into categorical pediatrics residency programs from 98% in 2017 to 91.8% in 2024,2 more pediatricians choosing to work part-time, and increased numbers of pediatricians leaving clinical practice to assume nonmedical roles,1 we urgently need to better support the current workforce and to help recruit and retain community pediatricians to teach future learners.The Pediatrics 2025: Association of Medical School Pediatric Department Chairs (AMSPDC) Workforce Initiative was created in 2020 to increase the number and diversity of high-quality students who enter training in pediatrics, medicine–pediatric, and combined pediatric subspecialty training programs and to improve the supply and distribution of pediatric subspecialists with the goal of meeting the health and wellness needs of the wide diversity of US children, adolescents, and young adults. These included redesigning undergraduate and graduate medical curricula to ensure pediatrics is an attractive career option for trainees, exposing learners to pediatrics early during training, and having pediatricians serve as role models during all levels of training.3The outpatient community pediatric office is a vital laboratory for experiential learning where learners are exposed to clinical, social, behavioral, practice management, and community pediatric issues not taught in hospital-associated primary care sites. These experiences are more likely to provide trainees with one-on-one mentorship, role models, and exposure to continuity.4 Additionally, research has demonstrated finding ways to make students more comfortable when they interact with children and improving the teaching skills of residents could improve recruitment of medical students into pediatrics.5 We believe the outpatient community preceptor plays a tremendous role developing these skill sets of comfortability with patients and effective teaching of residents.As medical schools and residency programs have increased in size, along with an increase in clinical and administrative demands of community physicians in practice, a “Preceptor Crisis”4 has emerged that threatens the ability to sustain the community pediatrics training model of learners. Qualitative surveys of community-based preceptors identified time and lack of teaching skills as 2 of the most common barriers to teaching in the office.6,7 Community preceptors also identified the need for more frequent and consistent communication with the medical school or hospital and more control in scheduling when they precept learners in their office.6 In addition, economic factors have contributed to independent community pediatricians either leaving to join a larger health care entity or to selling their practice to a larger health care entity.Informed by a recent survey of 200 AAP members who identify as community preceptors, conducted by the AAP Community Preceptor Working Group (unpublished to date), the authors have the following recommendations to combat this crisis (see Figure 1):Promote the benefits of precepting clinical learners in the office: Despite the highlighted challenges, community pediatric preceptors have identified many benefits to teaching learners in the office. These benefits can be split into 2 main groups: intrinsic and extrinsic. Intrinsic benefits include the joy of teaching, returning the favor of past mentorship, feeling connected to medical schools and hospitals, and developing mentorship opportunities and longitudinal relationships with learners. Extrinsic benefits include monetary compensation, volunteer faculty positions, access to subspecialists at hospitals, continuing medical education credit, access to university libraries, faculty development, faculty recognition, and other tangible benefits, such as preferred parking at the hospital.6 If we wish to ensure the survivability of community-based pediatrics, both publicly and privately owned, we must invest in recruiting and retaining community preceptors. This can be accomplished by focusing on and advocating for the extrinsic benefits outlined previously, in addition to promoting intrinsic factors. Better recognition of the teaching identity of community preceptors within academic departments and nationally will help prevent further decline in community preceptor teaching and optimize training for our medical students and residents.7Provide financial incentives for precepting: The financial burden associated with loss of relative value units and revenue by seeing fewer patients when teaching and lack of compensation for precepting results in pediatricians not being willing to either begin or continue precepting.7 Several institutions provide different benefits for precepting, some financial, but there is large variability across regions and specialties. Some states like Georgia, Hawaii, and Maryland offer an income tax credit for community-based preceptors, but there are numerous stipulations. Because of this variability, the authors urge the AAP to investigate and advocate for better financial compensation for community preceptors. AAP state chapters are in a unique position to advocate for tax benefits with their state legislators. This is an ideal area for the AAP to advocate with the American Association of Medical College’s Council of Deans and AMSPDC for medical schools and hospitals to offer financial incentives for precepting.Harness the power of the AAP to advocate for change: During the 2023 AAP Leadership Conference, a resolution to support the recruitment and retainment of community preceptors was passed and voted into the top 5 of all resolutions. This overwhelming support of the issue was a strong endorsement by AAP chapter, section, council, and committee leaders that this is a vital and crucial issue. The resolution asked the AAP to provide formal education and faculty development for community preceptors. While many organizations provide faculty development to their preceptors, we believe harnessing best practices and exporting them nationally would be beneficial. As noted earlier, working with state AAP chapters to advocate for financial benefits through state government is crucial. The AAP is an ideal organization to create and deliver preceptor education on best teaching practices, including adult learning theory, feedback, evaluation, and assessment. Medical learners need and expect competent clinical teachers. The authors, and other key stakeholders and AAP leaders, have formed a working group to address these issues, and a Listserv ([email protected]) has been created to share best practices.To summarize, the efforts to promote community preceptorship must increase; if not, we create an unsustainable future for the viability of community pediatrics. If the experience of the community pediatric preceptor can be improved and optimized, we believe this would have a positive impact on recruitment and retention of preceptors. We also believe this would positively impact the learner’s experience. We call for the support of pediatric organizations (such as the AAP), medical schools, and pediatric residency programs to help community-based pediatricians teach learners by providing greater educational resources, faculty development, and improved financial support. Our hope is to invest now in the support of community preceptors to ensure the longevity of the field by creating a collaborative, sustainable, and systematic approach across the country so that disparities are not exacerbated and workforce needs are met.Thank you to Scott Vergano, MD; Monique Soleil-Burke, MD; and Laura Degnon, CAE, for review of the manuscript. Thank you also to Hilary Haftel, MD, MHPE, for her review and for leadership in helping to create and support the AAP Community Preceptor Working Group.