The great debate on health-care reform is primarily about how to pay for medical services for all citizens. But that's only part the equation.

The other part, according to Dr. David Garr, is providing primary medical care for everybody, everywhere.

"It's not just about how to pay for it," said Garr, a family physician who heads the Area Health Education Center at the Medical University of South Carolina. "It's also about having the right people with the right skills in the right places to provide that care."

If we're really going to serve the under-served, he said, we're going to need thousands more doctors, and even more nurses working in under-served communities, or the system will be overwhelmed.

Garr recently met in Washington, D.C., with national health care professionals who concluded that major changes are needed in our medical education system.

These experts agree that more children need to be channeled into the fields of math and science, which will help.

Their analysis also calls for cataclysmic shifts in the way family doctors are paid, and rethinking the admission policies to medical school.

Money matters

To get to the heart of this issue, Garr says we need to take a look at our medical school environment.

"It's not an environment that fosters primary care," said Garr, who worked in rural Utah early in his career. "Even if students enter medical school with plans to become a family doctor, the system has made it easy for them to change their minds."

That's because med schools are filled with specialists who encourage students to pursue certain specialties for various reasons, including money.

By specializing, a physician can earn an estimated $3.5 million more during a career. Specialists also tend to work better hours and live in metropolitan areas.

In order to get more doctors into primary care in under-served areas, Garr says we need to adjust the bar on admissions to medical school. Just a little.

"Medical schools tend to see their role as recruiting the best and the brightest," Garr said. "It's no coincidence that most medical students come from the highest income populations."

Diverse mix

What Garr dares to suggest is that schools like MUSC, which selects 150 students each year, consider things other than perfect college grades and high entrance-exam scores when picking med students.

Basically, they want to attract a larger and more diverse mix of students. People from small towns. People from inner cities. People who might actually consider practicing in those places when they graduate.

"We're not looking for less qualified students," Garr said. "Just recognize those students who are most likely to come out of medical school with the same interests they came into medical school with."

If Garr and his colleagues can get a seat at the table of change, perhaps we could look forward to a world where doctors are more accessible, make a little less money and do it all for a cause much greater than themselves.

Imagine a world like that.