In 1970 the Virginia State Senate and House of Delegates passed a joint resolution directing the Virginia Advisory Legislative Council (VALC) to study the problem of the shortage of Family physicians in the rural and urban areas of Virginia.

RECOMMENDATIONS

RECOMMENDATION NO. 1: We recommend that MCV and UVa establish and expand family practice residency programs that meet the qualifying criteria of and are approved by the Residency Review Committee of the AMA. It is necessary that adequate funding be appropriated by the General Assembly in order to provide for the development of such family practice residency programs, Funds appropriated by the General, Assembly should be specifically earmarked for approved family practice residency programs on a cost per resident position basis. These residency positions must be created before they can be filled.

RECOMMENDATION NO. 2: We stress the need for Virginia's medical schools to teach family practice as an integral part of the medical curriculum. Adequate time must be allotted during the second, third and fourth years of medical school to assure that the students are fully exposed to the potentials of family practice as a career. Training must also be provided to insure that medical students clearly understand the techniques and methods by which high quality family medical care can be delivered.

RECOMMENDATION NO. 3: We recommend that the State medical scholarships offered each year be increased in amount from $1,500 to $2,500 each. MCV and UVa should each receive 40 such scholarships. Any scholarship not utilized by October 1 of any year by either school should be made available to the other school. The interest rate charged on scholarships not repaid by service in areas of need in the Commonwealth should be the prevailing commercial rate rather than the rate on student loans.

RECOMMENDATION NO. 4: We urge the State Department of Education to encourage high school guidance counselors to urge capable high school students to enter the study of medicine. Potential candidates should particularly be informed of the rewards of family practice. High school guidance counselors should stress medical careers due to the small percentage of Virginia's rural high school graduates who study medicine and also in view of the improved scholarship program recommended in this report.

RECOMMENDATION NO. 5: We recommend that the two State medical schools attempt to reach an enrollment of at least 75 percent Virginians as soon as possible. We do not recommend that a quota on resident and non-resident students be established by law.

RECOMMENDATION NO. 6: We encourage the General Assembly to consider favorably the development of a new private four-year medical school in the Tidewater area. Should the State legislature approve of giving aid to private institutions and should the Eastern Virginia Medical School (EVMS) be established, it is recommended that State funds be directly appropriated to EVMS on a per in-State student basis only and that these funds be used only for educational purposes and not for capital outlay and maintenance of the institution. Further, it is recommended that the medical scholarships also be extended to EVMS students when the school is established.

RECOMMENDATION NO. 7: We urge that the Virginia Council on Health and Medical Care be provided with an opportunity to expose medical students, house staffs, and faculties at MCV and UVa to the full resources of the Physician Referral Service of the Virginia Council.

RECOMMENDATION NO. 8: We recommend that the two medical schools develop plans for ideal rural group practices, and assist physicians and communities in setting up these facilities. By working in a group practice, the three or more doctors of the group could alternate being on call. Thus, better care could be provided, and the isolation and overwork so characteristic of solo rural practitioners could be avoided.

RECOMMENDATION NO. 9: We commend the Medical Society of Virginia and the Virginia Academy of Family Physicians for initiating studies on the use of paramedical personnel, and we recommend that they continue these efforts.

RECOMMENDATION NO. 10: We support the State Board of Medical Examiners' procedure of licensing physicians, including foreign medical graduates. Our quality of medical care must not be sacrificed by the licensing of inferior practitioners as a means of increasing our supply of physicians.

RECOMMENDATION NO. 11: We recognize that there has not been enough cooperation or coordination between the two medical schools, and we strongly urge that this relationship be improved. The schools have both established model family practice clinics or satellite teaching units and have yet to consider a provision to divide the State between the two established schools and the Tidewater area medical school when it is established.

We recommend that the administrators of MCV and UVa meet regularly and work closely to improve the health care of all Virginians. Such a working relationship is a necessity if the schools are to have a statewide coordinate system under which the family practice residency programs can operate.

RECOMMENDATION NO. 12: We recommend that for the purposes of research the admissions committees of both medical schools keep ongoing records of all applicants (accepted and unaccepted) which will include each applicant's name, place of origin, father's occupation, MCAT scores, and willingness to practice in Virginia for a period equal to the length of medical school training.

RECOMMENDATION NO. 13: Due to the crisis in family practice involving all citizens of the Commonwealth, we recommend that this study be continued for a two year period to keep abreast of developments and needs in this area.