Shift Educational Funding to Primary Care, Says New AAFP Workforce Report

The nation should adopt policies that will enlarge the primary health care workforce and stave off a growing primary care physician shortage, says a new workforce report approved by the AAFP Congress of Delegates on Sept. 27.

The workforce report says U.S. medical education policy should fund primary care residency programs -- particularly those that produce family physicians -- in order to produce a total of 4,439 family medicine graduates a year by 2020. That graduation level is needed to ensure that 30 percent of ambulatory care is provided by family physicians by 2020.

“Federal funding for graduate medical education should reflect physician workforce policy, with preferential funding for training primary care physicians, particularly family physicians, and concomitantly less funding for the training of other physicians,” the report says. “All payers of health care services should contribute to paying the costs of medical education.”

The report recommends formation of a public-private entity that would allocate funding for residency positions among training programs in accordance with the nation’s need for various specialties over time.

Estimates of future need for family physicians derive from data pointing to an aging population with more complex and chronic illnesses, fewer medical students entering primary care specialties, and more internal medicine physicians choosing subspecialty practice.

The AAFP workforce report cites several studies demonstrating the value of primary care in regard to both health outcomes and cost-efficiency, adding that the data suggest “that enhancing the primary care sector in the American health system may lead to marked improvement of the quality and cost issues currently challenging the nation.”

It notes, however, the current and growing shortage of primary care in general and family physicians in particular.

“Many nationally recognized groups, including the Council on Graduate Medical Education (COGME), the Association of American Medical Colleges, the Robert Wood Johnson Foundation and the Pew Health Professions Commission, have called for 50 percent of U.S. medical graduates to enter generalist careers,” the Academy workforce report says. “… Recent projections from multiple workforce reports and publications predict major shortages in primary care providers, especially for the adult population. … With the declining numbers of other providers of primary care, the number of ACGME (Accreditation Council for Graduate Medical Education) trained family physicians must be increased to meet the public’s need.”

Moreover, new physicians are opting for lifestyles that provide time for nonwork activities, according to research. For example, the workforce report said, a 2002 study in the American Journal of Medicine by Mark Linzer, M.D., professor of medicine at the University of Wisconsin Medical School, determined the workforce would require a 10 percent increase to accommodate new physicians’ changing lifestyles.

Without a renewed emphasis on training family physicians, the report warns, American patients will receive inappropriate care at greater cost, and the nation could fail at achieving universal access to care or meeting the needs of rural and urban populations.

“The increasing generalist-specialist imbalance in the United States undermines the nation’s ability to achieve universal health care access … ,” the report says. “Primary care services provided by limited specialists and subspecialists who have had little or no primary care training … can be expected to be both costly and inefficient as limited specialists tend to use technologies and procedures of their specialties more than generalists. … Services may be fragmented and duplicated by visits to multiple specialists, and preventive services may not be provided adequately.”