Match Results Prompt Call to Action

The 2007 National Resident Matching Program, known as the Match, had sobering news for Americans. At a time when research has documented a current shortage and growing need for family physicians across the nation, the number of U.S. medical school graduates opting for the specialty remains low.

After two years of minimal increases in the number of U.S. medical students matching to family medicine residency positions, the 2007 Match saw five fewer filled positions -- 2,313 this year compared with 2,318 in 2006. Also down was the total number and percentage of U.S. students who matched to family medicine; 1,107, or 7.8 percent, of U.S. graduates matched to family medicine this year, compared with 1,132, or 8.1 percent, in 2006.

The results show that "there's a detachment between America's medical school production and health care need," said AAFP President Rick Kellerman, M.D., of Wichita, Kan. "Medical schools and medical students are going one way, and the needs of society are going the other way."

Norman Kahn, M.D., AAFP vice president for science and education, agreed. The results demonstrate a continued "disconnect between the system for creating the nation's physician workforce and the needs of the larger community," he said.

Between 1992 and 2005, the Council on Graduate Medical Education, or COGME, had recommended that at least 50 percent of U.S. medical school graduates enter generalist or primary care medical practice. That changed with COGME's 16th report, which noted 38 percent of the nation's physicians provided primary care, "well below the 50 percent target recommended." Nevertheless, COGME dropped its recommended targets.

This year's Match data indicate COGME's approach isn't working, said Perry Pugno, M.D., M.P.H., director of AAFP's Division of Medical Education. "This is further evidence that the market-driven industry of health care is failing to meet America's present and expanding need for access to an efficient and cost-effective primary care system," he said.

Match results should spur state and federal legislators to closely examine their constituents' health care needs and compare them to the medical specialties their publicly funded medical schools are producing, said Kellerman.

Current health care policies create a practice environment that encourages students to choose subspecialties over primary care, thereby further impeding efforts to improve health care access, efficiency and quality, according to Kellerman. Without comprehensive health system reform, patients will have less access, higher costs and increasingly fragmented care, he said.

"This is not about family medicine; it's about what people need," Kellerman said. "Studies have shown that health care systems with a primary care base and family physicians have improved quality of care, cost less and provide better patient satisfaction. Research also shows that patients want a family physician to provide their health care and to coordinate other care when consultation is necessary."

Academy efforts for health system redesign -- such as upgrades in the relative value units for evaluation and management codes, action on medical liability reform, and private sector advocacy to reduce paperwork and improve payment -- "are beginning to get traction," said Kellerman. Now state legislatures need to step up to the plate, he added.

"State legislatures are supporting medical schools, and it would appear that public schools are not producing the type of physicians that their states need," Kellerman said. "Our legislators are asleep at the wheel. They issue calls for more doctors for their state, but we need to produce the right kind of doctors. Clearly we have shortages in primary care, but the states have lost their way."

Several studies have documented America's current shortage of primary care physicians, particularly in rural and underserved urban areas. Among them is a June 2006 Physician Workforce Study (PDF file: 32 pages / 543 KB. More about PDFs.) by the Massachusetts Medical Society which reported a "severe shortage" of family physicians and cited a Massachusetts Hospital Association survey that showed family physicians constituted the worst physician shortage in community hospitals.

"Unquestionably, this is a new labor market development of considerable concern," the report says, echoing concerns raised in a March 1, 2006, Journal of the American Medical Association article. There, researchers concluded, "The largest numbers of unfilled positions were for family physicians."

Such studies’ implications are borne out by data from Merritt Hawkins, a national physician recruiting company.

"Since 2003, demand for primary care physicians has increased substantially," the company says in its 2006 Survey of Final Year Medical Residents. (PDF file: 12 pages / 160 KB. More about PDFs.) Last year, 79 percent of primary care residents reported receiving 26 or more job solicitations, compared to 22 percent in 2001, the last time the survey tracked such data on primary care doctors.

"While recruitment activity directed at final year residents in specialty training diminished somewhat in 2006 relative to 2003, the amount of recruitment activity aimed at primary care physicians appears to have considerably increased," says the Merritt Hawkins report.

The shortage will only worsen, according to AAFP's Pugno. "The current environment of health care is driving medical students toward subspecialty careers, and we know that such care is more expensive and actually results in a worsening of community health outcomes when compared with a primary care-based health system," he said.

Pugno cited the AAFP's 2006 Family Physician Workforce Reform report, which calls for a workforce of 139,531 family physicians, or a ratio of 41.6 family physicians per 100,000 U.S. population by 2020.

To meet that demand, the nation's medical education system must produce a total of 4,439 new family physicians each year, the report concludes.

The AAFP has continued to promote interest in family medicine careers through several avenues. Among them is by

“Given the long lag time between entry into medical school and completion of residency -- at least seven years -- we do not have time to wait," said Kellerman. "Policy-makers must understand that fewer students entering family medicine residency programs spells decades of future problems for baby boomers, their parents and their children.”