April 2000 • Volume 6 • Number 4
Decrease is bad news for Americans
Primary care match results down overallBY CINDY McCANSE
Family practice lost ground in the National Resident Matching Program for the third year in a row, according to data the NRMP released March 16. Perhaps more disturbing is that for the first time in recent history, both the total number of residency positions filled with U.S. seniors and the fill rate for U.S. seniors were down for all primary care categories: family practice, pediatrics-primary, internal medicine-primary and combined IM/pediatrics.These figures could herald a downturn in primary care residencies.
The 2000 fill rate for family practice residency programs was 81.2 percent -- 2,603 positions filled out of 3,206 offered. The 1999 fill rate was 82.6 percent. The specialty filled 94 fewer total positions in 2000 compared with 1999, and U.S. seniors filled 191 fewer positions.
Two of the other primary care categories -- pediatrics-primary and internal medicine-primary -- also had declines in total numbers of positions filled this year. For combined internal medicine/pediatrics programs, although the total number of positions filled actually increased by 10, nine fewer positions were filled with U.S. seniors.
The three-year downward trend in family practice programs comes on the heels of seven solid years of increasing match numbers: From 1991 through 1997, the number of filled family practice positions steadily rose, including four consecutive years of record-breaking numbers of positions filled (1993 through 1996).
According to AAFP President Bruce Bagley, M.D., of Albany, N.Y., the drops among primary care categories in 2000 bode ill for Americans.
"Primary care physicians keep America healthy by offering high-quality, up-to-date health care that focuses on prevention," he said. "If the number of medical school graduates choosing primary care careers continues to decline, there won't be enough primary care physicians to treat our growing population. Obviously, the health of the public will be hurt.
"We are issuing a call to all those who are concerned about ensuring a healthy America -- this trend must be reversed."
A number of factors have contributed to the decline, Bagley said, not the least of which is students' concern about incurring substantial medical school debt. Despite the current rise in salaries for primary care physicians, the rate of increase is quickly outstripped by educational indebtedness.
Lifestyle is another factor Bagley cited. "Family practice involves a high degree of commitment to patients," he said. "Development of the close doctor-patient relationship that is the hallmark of family practice requires time and skill, but yields immeasurable rewards."
Perry Pugno, M.D., M.P.H., director of the AAFP Division of Medical Education, holds a similar view. "Family physicians care about the public. We belong to a values-driven specialty," he said. "We need to be sure that those values and the rewards of family practice are being conveyed to medical students.
"But we must also ensure that we are educating our patients about the specialty of family practice in the same way that we tell them to get their immunizations or teach them about prevention. We need to educate them to become proactive about legislative issues affecting family practice."
FP Report is published by the AAFP News Department.
Copyright © 2000 by American Academy of Family Physicians.
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