After a downturn in 2009, more U.S. medical students chose family medicine as their specialty this year, resulting in a fill rate of 91.4 percent, the highest percentage for family medicine ever, according to the results of the 2010 National Resident Matching Program(www.nrmp.org), or NRMP, also known as the Match.
Match results show that 2,404 family medicine positions were filled out of 2,630 positions offered, for a fill rate of 91.4 percent, the highest percentage of family medicine positions ever filled in the NRMP, according to Perry Pugno, M.D., M.P.H., the director of the AAFP Division of Medical Education. Residency positions in the family medicine category also include family medicine-psychiatry, family medicine-emergency medicine and family medicine-internal medicine combined programs.
In addition, 75 more family medicine positions were offered in 2010 than in 2009, an increase of 2.9 percent. Match results also show that 1,184 graduating U.S. medical students -- 101 more students than last year -- filled family medicine residency positions in 2010, resulting in the highest number of U.S. seniors matching into family medicine since 2004, said Pugno.
Federal and state health care reform efforts have heightened awareness of the need for patient-centered primary care services that increase quality and outcomes, said AAFP President Lori Heim, M.D., of Vass, N.C. This undoubtedly has encouraged more medical students to choose family medicine.
Health care efforts have "renewed interest in primary care and provided a framework for the future," Heim told AAFP News Now. "All of these things are noticed by the medical students, and they see that family medicine is not only personally rewarding but very viable in their future."
She noted that the Academy will continue its commitment to a health care system that is balanced and equitable so the number of students who choose to specialize in family medicine and primary care will continue to climb in the future.
Pugno agreed that federal and state health care reform efforts have shifted interest toward primary care. "The tide is turning," he said. However, he added, "this shift toward primary care careers is dependent on the legislature providing better support for primary care. The big variable is the promise of improved payment for primary care services."
For the first time, all 14 residencies(www.transformed.com) in the Preparing the Personal Physician for Practice, or P4, Demonstration Initiative(www.transformed.com) filled their open positions during the Match, according to Perry Pugno, M.D., M.P.H., director of the AAFP Division of Medical Education.
The P4 family medicine residency training programs feature innovations associated with the patient-centered medical home, or PCMH, model of care, ranging from residents who participate in practice-learning teams, the use of various electronic resources, a fourth year of training for more advanced skills, a curriculum with a lifestyle medicine track, and an initiative that focuses on developing executive skills.
Pugno said the innovations in the P4 programs very likely attracted many medical students to these residencies. The filling of these residencies "is one of the many indicators we have that the medical student community understands the value inherent within the PCMH and in patient-centered care," Pugno said.
The P4 program is a collaboration of TransforMED, the Association of Family Medicine Residency Directors, the American Board of Family Medicine, and the Oregon Health and Science University Department of Family Medicine.
In addition to family medicine, other primary care specialties, including internal medicine-primary care and internal medicine-pediatrics, also had increases in the number of U.S. seniors filling their residency positions. Seven more positions were filled in internal medicine-primary in 2010 than in 2009. Sixteen more positions were filled in internal medicine-pediatrics in 2010 than in 2009.
"The need for a primary care base is obvious enough and those who want to be the physicians of the future are starting to make decisions in that direction," Pugno said. "This is indicative that the pipeline (of future primary care physicians) is willing to respond if the future looks optimistic."
The majority of positions offered and filled in the NRMP, however, continue to be in nonprimary care subspecialties. For example
- 48 more students chose anesthesiology as their specialty this year over last year for a total of 771;
- 36 more U.S. seniors selected emergency medicine, or 1,182 in 2010 versus 1,146 in 2009;
- 36 more U.S. seniors chose obstetrics-gynecology for a total of 915 in 2010; and
- 71 more U.S. seniors chose surgery-categorical -- 895 versus 824.
Although the 2010 NRMP results show an uptick in the number of medical students choosing primary care specialties, many more students need to make this choice, said Pugno. In fact, the Council on Graduate Medical Education, or COGME, is recommending that current trends toward specialization be reversed.
According to COGME, the U.S. physician workforce needs to be made up of at least 40 percent primary care physicians, and this specialty distribution should be accompanied by payment reform to substantially increase reimbursement for primary care services.
The AAFP adopted a new workforce policy statement in 2009 that makes recommendations to ensure a strong family medicine workforce. It notes that "primary care is essential to any efficient health care system. In order for the United States to control costs, reduce health disparities and deliver high-quality care, the primary care workforce must be strengthened and deployed in a manner consistent with the health needs of the population."
In addition, said Heim, the income gap between primary care and other subspecialties continues to widen, and that must be addressed. Health care reform efforts must seek to further increase the number of medical students choosing family medicine, must support family medicine residency programs in training physicians for the future and must achieve payment reform to sustain the practice of family medicine and preserve health care access for the American people, she noted.