Town Hall Participants Mix Support, Questions on Workforce Study

A new AAFP national workforce reform report that calls for a 39 percent increase in family physicians by 2020 is part of comprehensive health care reform designed to provide “what’s best for the country,” according to Academy leaders.

The report, presented during a Sept. 25 Congress of Delegates Town Hall meeting in Washington, D.C., calls for a family physician workforce of 139,531, or 41.6 FPs per 100,000 people, by 2020. To reach that goal, family medicine residency programs must increase residency slots from an average of 21 to 24, and the system must graduate 3,725 family physicians from Accreditation Council for Graduate Medical Education-accredited residencies and 714 from American Osteopathic Association-accredited residencies each year.

“This study verifies what most of us already feel, particularly with the increase in chronic health problems patients have and the retirement of family physicians we’re going to start seeing in five to 10 years,” said incoming AAFP President Rick Kellerman, M.D, of Wichita, Kan.

The Academy workforce report demands systemwide change, according to outgoing AAFP Board Chair Mary Frank, M.D., of Mill Valley, Calif.

“It isn’t based on the current system, but (on) what would be best for the United States,” she told Town Hall participants. “These numbers are predicated on not having the dysfunctional system we have now. This report is based on the question, ‘What do the people of the country need?’”

The study focuses on future demand for family physicians — given the new model of care — and the residency graduate production to meet that demand.

Under the new model of care, family physicians will be more productive. However, the study notes, that increased productivity will be offset by growing demands as an aging population develops complex, chronic conditions and as the number of uninsured and underinsured patients grows.

Moreover, only 13 percent of this year’s internal medicine graduates plan to enter primary care, and more nurse practitioners and physician assistants are limiting their scope of care, according to Frank. Family physicians, she said, must fill the gap.

But how, asked Town Hall participants, who pointed to lagging student interest and a payment system that undervalues primary care. A starting point, said Kellerman, is to push medical school admissions committees to revise their criteria to encourage students from all socioeconomic and ethnic backgrounds.

“These committees ask students, ‘What research have you done?’ If you’re from a lower socioeconomic background, you might have worked your way through school and didn’t have time for research,” he said. “Or they ask, ‘What international experience have you had?’ If you have few funds, you can’t afford that kind of travel.”

New Jersey delegate Richard Cirello, M.D., of Verona, said family medicine could encourage interest in family medicine by “improving the lot of family physicians.”

True, said outgoing AAFP President Larry Fields, M.D., of Ashland, Ky., who outlined several successful Academy initiatives during his Sept. 25 speech to the Congress of Delegates. Among them: “significant increases” in the value of evaluation and management codes and outreach to corporations, such as IBM, which is working with the Academy to design a health care system for its employees.

Still, without changes in graduate medical education funding rules, increasing family medicine residency positions remains challenging, according to Michigan delegate William Gifford, M.D., of Williamston.

“There’s a total lockdown on the number of residency slots, and without changes from the (U.S.) Congress or CMS, hospitals would have to pay out-of-pocket” to increase residency positions, he said.

AAFP leaders agreed federal funding policy for graduate medical education must change, but part of that change could incorporate insurance company contributions. The workforce report calls for a public-private entity to allocate graduate medical education funding that would be provided by all public and private insurance payers of health care services.