Football quarterbacks become household names for a reason: They’re key to their teams' success, leading plays that require the cooperation of multiple athletes to achieve a goal.
Dr. Phyllis MacGilvray, dean of the University of South Carolina’s School of Medicine Greenville, says a football team is a great analogy for how health care providers work together for a patient.
“A good primary care doctor is like the quarterback of the football team,” MacGilvray says. “They call the shots and coordinate care.”
Without a primary care physician, costs can go up — or worse. A sore throat could result in an emergency room visit. Care could suffer if a patient is seeing multiple specialists but there is no primary care doctor coordinating.
“A good primary care workforce reduces the cost of health care across the nation,” MacGilvray says.
At both of USC’s medical schools, in Greenville and Columbia, producing more primary care doctors is a top priority. The Cicero Institute predicts that by 2030, South Carolina will be short 3,230 doctors — with 815 of those doctors missing from primary care. To help address this, the schools are working to recruit and retain more students who intend to work in primary care in the state.
Appointed to a two-year deanship in 2024, MacGilvray’s specialty is in family medicine, a branch of primary care in which physicians serve patients of all ages.
“One of the things I hoped about becoming dean as a family medicine doctor is being able to circulate the importance of good primary care,” says MacGilvray, who pursued family medicine after seeing the impact of role models serving in her hometown of Abbeville, South Carolina.
MacGilvray isn’t alone in this mission: Dr. Gerald Harmon, USC School of Medicine Columbia’s interim dean, is also a family medicine specialist. In fact, all four medical schools in South Carolina currently have deans who specialize in family medicine.
A past president of the American Medical Association, Harmon says family medicine is especially relevant in South Carolina because of the aging population, with about 27 percent of the population projected to be over age 60 by 2030.
“With an aging population, we have a burden of disease that is increasing and stressing the system,” says Harmon, who has been practicing family medicine for more than 40 years, with much of that in rural or underserved communities in South Carolina.
Harmon says family medicine is helpful in these areas because a single doctor can provide primary care for any member of the community, from the youngest to the oldest, even coordinating care for entire families.
“If you become the family doctor, you can see your patients for generations,” he says.
Prioritizing primary care
Harmon says the School of Medicine Columbia does well in recruiting physicians who choose primary care, with a substantial number of graduates going into primary care and staying in the state. The medical school emphasizes primary care through its South Carolina Center for Rural and Primary Healthcare, which helps to develop and support education and health care delivery statewide.
In addition, the medical school offers a wide range of programs to help bring more primary care to rural areas in South Carolina.
“Part of what we're doing is using telehealth and digital medicine to expand the discipline so that primary care can have more reach in underserved areas like Barnwell, Williamsburg County, Georgetown and Jasper County,” Harmon says.
But to tackle the doctor shortage, Harmon says, it will take more than one strategy.
“The way we’re going to make progress is not just by recruiting more health care providers, but by reducing the burden of disease,” he says.
To do that, doctors are increasingly turning to lifestyle interventions to help patients prevent and reduce chronic conditions.
A focus on lifestyle
At the School of Medicine Greenville, a relatively new field called lifestyle medicine is a foundational component of the educational program. Lifestyle medicine incorporates evidence-based lifestyle interventions to inform patient care holistically. If a patient has high blood pressure, a lifestyle medicine physician may consider various factors, from physical activity and nutrition to stress levels and loneliness, to recommend a treatment plan.
“I’ve had success in getting a patient down from four blood pressure prescriptions to one through lifestyle changes and a milled flaxseed regimen, which data shows to have similar effects as some blood pressure medications,” MacGilvray says.
Nutrition is one of the six pillars of lifestyle medicine, and both medical schools have programs to help community members, practitioners and students learn how to cook and eat for improved health. At the School of Medicine Columbia, FoodShare South Carolina offers a culinary medicine program, with nationally accredited curriculum geared for first- and fourth-year students.
MacGilvray says that as students and practitioners learn and implement the principles of lifestyle medicine, they often experience positive changes in their own health as well.
What’s needed: More doctors + less disease
Since coming to Greenville in 2018, MacGilvray has become certified by the American Board of Lifestyle Medicine. She is the first medical school dean in the United States to hold this certification. As a leader, she has helped increase the medical school’s number of clinical educators with board certifications in family medicine and in lifestyle medicine.
In partnership with Prisma Health, MacGilvray helped launch the Primary Care Accelerated Track (PCAT) at the School of Medicine Greenville to offer students full tuition to complete medical school in three years if they choose primary care and stay in South Carolina for their residency and four years of practice with Prisma Health.
“It’s basically a train and retain model,” MacGilvray says. “Our accelerated medical curriculum trains students in three years instead of four, provides clinical immersion and mentorship from family medicine faculty and residents, and accelerates their start in residency.”
After the first cohort started in 2024, interest in the program has tripled, and MacGilvray hopes to see the program expand in coming years.
“Many people realize medical school is very expensive, but this program alleviates the debt burden, making it a little easier for students to choose careers in primary care,” she says.
As those students enter the workforce, they’ll become the medical quarterbacks of their communities — crucial players in the effort to improve the health of South Carolinians.
“We can reduce that burden of disease by preventative medicine, educating patients about healthy living through lifestyle medicine, proper screening and timely treatment,” Harmon says. “And family doctors are among the best positioned to do that.”