Source: American Academy of Family Physicians
Interest in family medicine continued its upward trend for the seventh consecutive year, according to the 2016 National Residency Matching Program (NRMP) results released on March 18.
Known as the Match, the NRMP aligns graduating medical students with residency training programs in specialties the students want to pursue. This year, the total number of medical students choosing family medicine was 3,105, up 45 from the 3,060 last year. The number of U.S. medical school graduates choosing family medicine was 1,481, up 59 from 2015.
“Although we’re pleased that interest in family medicine is holding steady, the nation needs for that interest to rise dramatically,” said Wanda Filer, MD, president of the AAFP. “We’re particularly pleased that the increase of U.S. medical students choosing family medicine jumped from six in 2015 to 59 this year. However, this year’s overall Match number is the smallest growth since 2012 when we saw a total increase of 327 students matching to family medicine. That has fallen to a total increase of 45 this year.”
The 2016 Match results come at a time when an aging population requires the expertise of physicians who can manage multiple complex chronic conditions.
“I like to say that students who choose family medicine are choosing a full-scope medical career that serves the needs of our nation,” said Filer. “I tell students that when you choose family medicine, you choose more than one organ system, more than one gender, more than one age. We serve everyone.”
Two recent studies by the Robert Graham Center demonstrated the complexity of family medicine. One, “Complexity of Ambulatory Care Visits of Patients with Diabetes as Reflected by Diagnoses Per Visit,” showed that primary care physicians provide far more complex care as measured by the number of health problems address in each patient visit. A second, “Accounting for Complexity: Aligning Current Payment Models with the Breadth of Care by Different Specialties,” showed that primary care physicians grapple with 23 diagnostic codes in caring for their patients while subspecialists such as cardiologists use a median of six codes and psychiatrists use three.
Moreover, a recent snapshot survey of AAFP members demonstrated that complexity. According to the survey, seven in 10 respondents have experienced an increase in the number of health issues addressed in a single office visit; more than half said more patients sought treatment for conditions they had previously ignored, and more than four in 10 said they witnessed an increase in patients with severe health complications.
Several policy options would address the trickle that is entering the primary care physician pipeline, according to Filer. Among them are:
- Make the Teaching Health Center Graduate Medical Education Program a permanent program that is supported through the U.S. Centers for Medicare and Medicaid graduate medical education (GME) funding. The program funds new primary care residencies at community health centers that care for underserved patients. Research from the Robert Graham Center, “Graduates of Teaching Health Centers Are More Likely to Enter Practice in the Primary Care Safety Net,” shows that nearly twice as many primary care medicine residents who trained in teaching health centers went on to practice in underserved settings as did their counterparts who trained in hospital-based programs.
- Implement policies that hold GME funding accountable for the tax dollars invested in medical education. The AAFP’s Aligning Resources, Increasing Accountability, and Delivering a Primary Care Physician Workforce for America, calls for greater accountability and transparency in the GME system and an alignment of national investment in meeting the physician workforce needs of the country. The proposal also creates a mechanism to ensure that the training of physicians occurs in the most appropriate settings and not solely in a hospital.
- Develop programs that encourage young people from underrepresented ethnic populations and rural areas to go to medical school. Researchers have identified student characteristics that are significant predictors of choosing primary care and practicing in underserved areas: rural birth, interest in serving underserved or minority populations, and attending a public medical school.