Academy to Examine Impact of Residency Closures

The AAFP Division of Medical Education is launching a study into factors contributing to the closure of family medicine residency programs around the United States and efforts to prevent those closures. The study will provide both quantitative and qualitative measures of the reasons behind and the effects of residency program closures, according to lead investigator Amy McGaha, M.D., assistant director of the AAFP Division of Medical Education.

When completed, the study will augment earlier research on factors related to program closures and provide fodder for discussions with legislators and health policy analysts.

"We're going to be exploring in more depth the research that previously looked at this issue and at the implications of the closures," said McGaha.

She noted that previous research (PDF file: 5 pages / 61 KB. More about PDFs.) published by English Gonzalez, M.D., and her co-authors in the November-December 2003 issue of Family Medicine found that financial considerations rather than poor program quality, program length or contributions to the community topped the list of reasons for program closures.

McGaha will focus on residency training programs that have closed since 2000. She will investigate

The Robert Graham Center in Washington has published maps that provide additional information about the implications of closing residency programs on the medical and patient communities served by the programs. (See "Waving a Caution Flag: Residency Closures Can Affect Access to Care.")

Family physicians who observed or were involved in a family medicine residency closure can contact McGaha at AMcGaha@aafp.org.

The closures come at a time when demand for family physicians is up, according to the 2005 Review of Physician Recruitment Incentives (PDF file: 12 pages / 327 KB. More about PDFs.) by Merritt, Hawkins & Associates, a national physician recruiting company. Recruitment notices also have increased at AAFP Placement Services and in American Family Physician, and researchers have documented the growing shortage of family physicians in community health centers in "Shortages of Medical Personnel at Community Health Centers: Implications for Planned Expansion," in the March 1 Journal of the American Medical Association. In June, the AMA Board of Trustees approved a policy calling for improving the balance between generalists and subspecialists in the physician workforce.

Yet despite the increasing demand for family physicians, 37 family medicine residency programs have closed their doors in the past five years. Most recently, the Duke University School of Medicine announced plans to shut down its family medicine residency program.

Such closures are likely to have a direct impact on the communities served by residency programs, according to Gonzales' research.

"The majority of closures … affect community-based programs and those operating in public or nonprofit hospitals," she and her co-authors wrote. "If this signals a trend in disproportionate closure of community-based and nonprofit hospital-sponsored programs, it may have a greater effect on underserved and rural populations."

Moreover, "closure of medical school programs may further limit the exposure of medical students to family medicine as a career option and affect the family practice workforce far into the future," they said.