For more than three decades, the AAFP has been slicing and dicing data from the National Resident Matching Program -- more commonly referred to as the Match -- in a concerted effort to track the number of medical students choosing family medicine as their specialty.
The 34th iteration of that effort appears in the October 2015 issue of Family Medicine as a pair of articles authored by a team from the AAFP's Division of Medical Education.
This year, authors took a different angle, said lead author Stan Kozakowski, M.D., director of the division. He pointed out the value of sifting through more than 30 years of data.
"This is the first time that I'm aware of that we specifically looked at the Match and compared the highs and the lows -- peaks and troughs, if you will -- and that was very illuminating," Kozakowski told AAFP News.
The first article(www.stfm.org) compared the results of the 2015 Match with numbers from the 1997 and 2009 Matches.
Authors chose those specific years for a reason: 1997 represented the high-water mark for family medicine, with the most family medicine positions ever offered and the most positions filled by U.S. seniors, and the 2009 Match yielded the lowest numbers in both categories.
- In two recently published articles, AAFP experts compared historic National Resident Matching Program data and looked at U.S. graduating seniors' entry into family medicine programs.
- Authors found that despite a 31 percent hike in the number of U.S. seniors who have matched into family medicine since 2009, the number remains 39 percent lower than the number who matched to the specialty in 1997.
- They also concluded that U.S. M.D.-granting medical schools are still failing to produce an adequate number of students choosing specialties that lead to careers in primary care.
In the second article,(www.stfm.org) authors tracked the entry of U.S. medical school graduates into family medicine residencies in 2014-15.
Together, the two articles make a powerful case for the urgency of filling the primary care pipeline if the country is to achieve the triple aim of improved care, better health and reduced costs.
Key Findings, Comparing Data
The AAFP team that studied Match data from 1997, 2009 and 2015 highlighted some sobering findings.
"Despite the steady annual increase in the number of family medicine positions offered (26 percent) and filled (31 percent) in the Match since 2009, those measures were still lower in 2015 than the peak in 1997," the authors wrote, specifically referring to the proportion of residency positions filled by U.S. graduating seniors.
Even with that 31 percent hike in the number of U.S. seniors who have matched into the specialty since 2009, the number remains 39 percent lower than the number who matched to family medicine in 1997.
"That, to me, was the most telling of all the things we came across," said Kozakowski.
Also striking to authors was the 10 percent drop in positions offered by all primary care specialties combined in 2015 compared with 1997 -- a total of 442 fewer positions.
Finally, the 2015 Match saw 1,194 fewer U.S. seniors match into primary care compared with the 1997 Match.
But even amid those downward trends, Kozakowski pointed out a positive. He called it "telling" that of all U.S. seniors matching into primary care in 2015, the vast majority -- 69 percent -- chose family medicine.
"We're not the only game in town, but we represent the biggest piece of that primary care pie," he said.
Family Medicine Residencies
Kozakowski and his team summed up their look at the entry of U.S. seniors into family medicine programs in 2014-15 in a single quote:
"It is clear that in aggregate, U.S. M.D.-granting medical schools are failing to produce an adequate number of students who are choosing specialties that will lead to a career in primary care," they wrote.
Authors highlighted that
- about 8.5 percent of the 18,241 students who graduated from U.S. M.D.-granting medical schools between July 2013 and June 2014 entered a family medicine residency;
- some 80 percent of those 1,458 graduates came from 69 of the 131 medical schools;
- the 11 medical schools that don't have family medicine departments or divisions sent only a combined 26 students into family medicine; and
- 46 percent of first-year family medicine positions accredited by the Accreditation Council for Graduate Medical Education were filled by M.D.-granting medical school graduates in 2014, followed by graduates from international and D.O.-granting medical schools (36 percent and 18 percent, respectively).
And as in past years, authors noted that location matters -- a lot -- when it comes to medical school graduates choosing a career in family medicine.
Medical schools west of the Mississippi represent only one-third of all U.S. M.D.-granting schools, but the rate of students from those schools who selected family medicine was two-thirds higher than the rate among students who graduated from medical schools east of the Mississippi.
Kozakowski said the findings "dovetailed nicely" with the 2014 release of an AAFP proposal that calls for an overhaul of the nation's graduate medical education (GME) system.
"The Academy and other stakeholders are demanding accountability and transparency on the part of U.S. medical schools" so the nation's primary care health needs can be met, said Kozakowski.
Closing the Deal
Kozakowski acknowledged that historically, the income gap between average subspecialist and primary care physician salaries has had an effect on student choice.
But he said that a systemwide movement toward value-based payment, as dictated by the Medicare Access and CHIP Reauthorization Act of 2015 is reason for hope.
"As we move to a value-based payment system that rewards family physicians for the quality of care they deliver, we should anticipate, based on history, that the income gap will diminish and student interest in family medicine will be revived," said Kozakowski.
But there's more to be done, and some of the load must be shouldered by family physicians, he added.
"We need to close the deal on converting student interest in family medicine to student choice of family medicine," said Kozakowski.
Physicians can serve as role models and mentors, and their efforts must include a focus on practice changes that ultimately demonstrate value and lead to increased payment, he added.
Kozakowski reminded his colleagues that today's medical students are not satisfied with merely being "passive observers of care."
"Rather than simply having students shadow you in practice, partner with them to discover how they can help you deliver better care," said Kozakowski. "Let them participate in patient risk stratification, or ask them to create a patient advisory panel," he added.
"It is that partnership with a student who wants to be a part of the health care solution -- with a physician who is willing and able to engage them in the process -- that will drive student choice."
Kozakowski concluded that the articles, although sobering, "Show us a call to action."
Related AAFP News Coverage
2015 Match Results
AAFP Celebrates New Recruits to Family Medicine, Acknowledges Work Ahead
More From AAFP
GME Policy Paper: "Aligning Resources, Increasing Accountability and Delivering a Primary Care Physician Workforce for America"(7 page PDF)