April 2001 • Volume 7 • Number 4
Worrisome trend continues
Specialty, primary care lose ground in 2001 matchIt's dropped again -- the number of individuals matching in family practice residency positions, as well as in the positions of other primary care categories. This is the fourth consecutive year that family practice and primary care have lost ground, according to preliminary data released March 22 by the National Resident Matching Program.
Data show that 2,363 family practice positions were filled out of the 3,096 available, for an overall fill rate of 76.3 percent. That's a far cry from the halcyon days of the mid-nineties, when the family practice fill rate rose from 1992 through 1997.
And it's bad news for America, says AAFP President Richard Roberts, M.D., J.D., of Madison, Wis.
"Medical students are clearly demonstrating a preference for medical subspecialties -- and yet studies show that Americans rely on family physicians more than any other specialists for health care," says Roberts. "As America's population continues to grow, there won't be enough of us to meet future needs if the present trend continues.
"Instead, there will be more subspecialists trained to care for individual health problems -- but not enough doctors trained to care for the whole person and the whole family."
The numbers
NRMP data show that 2,363 family practice positions were filled out of the 3,096 available, for an overall fill rate of 76.3 percent. Last year, it was 81.2 percent.
Fewer U.S. seniors are selecting family practice as well. Of U.S. seniors matching this year, 11.2 percent matched in family practice, compared to 13.6 percent last year.
All primary care programs -- family practice, pediatrics-primary, internal medicine-primary and internal medicine-pediatrics -- had lower overall fill rates this year. Total positions filled by U.S. seniors decreased in all primary care programs.
Go to http://www.aafp.org/match for more details of the 2001 NRMP results.
Understanding the trend
Why are more medical students choosing subspecialties? "Some anecdotal evidence indicates that students are attracted to the lifestyle of subspecialists, especially in regard to schedule demands and financial implications," says Roberts. "Many subspecialists face fewer external productivity pressures -- and they get better pay for their work."
Medical school debt is one key concern. According to the Association of American Medical Colleges, the average student's debt is more than $94,000.
"Once they get into practice, they have to pay that off, and they also have to start building a financial base for their children and their own long-term future," says Roberts. But other specialists' salaries often are two to three times higher than primary care salaries.
Stemming the tide
The Academy's well down the road when it comes to analyzing students' growing disenchantment with family practice. Some specifics:
- A University of Arizona study will evaluate the factors that influence students' specialty selection.
- Family practice organizations have embarked on a long-range strategic planning effort that includes an in-depth analysis of the specialty to help determine its future direction (see story on page 1).
- The AAFP recently established a Commission on Resident and Student Issues, which will first meet in June.
- Finally, the AAFP continues to aggressively seek relief for practicing FPs in the areas of equitable reimbursement and the reduction of government regulations and paperwork hassles.
"We know practicing FPs are struggling right now," says Roberts. "We know it's a challenge to present a positive picture when the difficulties of daily practice are so overwhelming. We're working to make it better, so that family physicians can more easily recall why they went into family practice in the first place -- and pass the enthusiasm on to students who look to them as role models."
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
FP Report | Headlines |AAFP Home | Search