Jones & Bartlett Learning Medicine Blog

    Family Medicine Enrollment Grow in 2012 – Still Room for Concern

    Posted by admin on Mar 29, 2012 1:05:32 PM

    According to the National Resident Matching Program (NRMP), also known as the Match, family medicine attracted more graduating medical students in 2012, marking an increase in the field for the third year in a row.

    The Match data provided by the American Academy of Family Physicians (AAFP) includes family medicine, family medicine-psychiatry, family medicine-emergency medicine, family medicine-preventive medicine and family medicine-internal medicine programs.

    This year, family medicine residency programs filled 2,611 positions out of 2,764 positions offered, for a fill rate of 94.5 percent. However, this only a slight improvement over last year's record-breaking rate of 94.4 percent.

    A total of 1,335 U.S. seniors matched to family medicine in 2012 - an increase of only 18 seniors compared to last year. But for the first time since 2002, there were fewer participants in the NRMP: 16,527 in 2012 versus 16,559 in 2011.

    Despite the fact that the 2012 numbers show continued growth in the field, there is still some cause for concern.

    AAFP President Glen Stream, MD stated in a recent report:

    "Americans need access to primary care doctors, and the path to filling that pipeline with future family physicians is clear," said Stream. "Several things need to happen, including narrowing the income gap between primary care and other physician specialists, reforming the medical education infrastructure, changing the system that funds graduate medical education, and increasing support for programs such as the National Health Service Corps and health professions training programs."

    Tarascon author, Joseph Esherick, MD, FAAFP also shares his thoughts and concerns:

    This year only 11.4% of medical students chose to enter a Family Medicine residency program.  This is particularly concerning because the new Healthcare Reform bill, or Affordable Care Act, could provide insurance to 30 million new patients in this country by 2014.  Some experts have estimated that the country will need at least 15,000 additional primary care providers to accommodate these new patients.  This increase is in addition to those residents physicians expected to be practicing by 2014.

    My colleagues and I feel that the most significant barriers to the choice of family medicine for medical students are debt burden and a misconception of the scope of family medicine.  Unfortunately, the current system that has been perpetuated by the American Medical Association and the current RVU-based system reimburses specialists far better than it reimburses primary care physicians.  The RVU-based system prioritizes medical procedures over thinking and acute care over chronic disease management.  The current system favors interventional and reactive medicine over preventive medicine.  Therefore, the medical student faced with a large debt burden is enticed to enter a specialty with a much higher rate of reimbursement as opposed to a primary care specialty like family medicine.

    The other problem that sways medical students from family medicine is the misbelief that family physicians only see patients in the clinic with depression or colds.  All family physicians are trained to deliver babies and care for newborns and graduates from select family medicine residency programs, such as the Ventura Family Medicine Residency Program, are capable of working as an emergency physician or a hospitalist.  However, although graduates of such programs are capable of practicing full-spectrum family medicine, the opportunity is often lacking because hospitals mainly need “gatekeepers” for their clinic systems and hire on new graduates as their employees.

    The future looks bleak for family medicine unless major changes are instituted at the Federal level to alter the current system of reimbursement and to better utilize the skills of family physicians.

    What are your thoughts on Family Medicine’s enrollment not meeting the overall demands of this growing field?

    Topics: Affordable Care Act, primary care, Dr. Joseph Esherick, Family Medicine, Glen Stream, Healthcare Reform Bill, Authors, National Resident Matching Program, AAFP, American Academy of Family Physicians, American Medical Association, internal medicine, Match, NRMP

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