Fewer Medical Students Choose Family Medicine in 2009 Match
Shaky Economy, Concerns About Indebtedness Are Factors, Say AAFP Leaders
By Barbara Bein
3/19/2009
After a slight uptick in 2008, interest in family medicine among U.S. medical students has returned to its 10-year decline, as a shaky national economy and the prospect of high medical school debt appear to be luring graduating seniors into specialties other than primary care. That's the scenario suggested by the results of the 2009 National Resident Matching Program, known as the "Match," say Academy leaders.
The results show that 1,083 graduating U.S. medical students -- 89 fewer than last year -- chose family medicine as their career path. But the good news is that 2,329 of 2,555 family medicine residency positions were taken, for a fill rate of more than 91 percent, slightly greater than last year.
AAFP leaders point to the uncertainty of the economy and the murky future of such federal programs as the debt-to-income ratio component -- known as the "20/220 pathway" -- of the economic hardship loan deferment, which allows resident physicians to postpone paying back their school loans during the first three years of their training.
Last August, the Academy and other organizations asked the U.S. Department of Education (4-page PDF; About PDFs) to permanently restore the pathway, which was eliminated in 2007, or to provide an equivalent funding mechanism for loan deferments. To date, the department has not acted on that request.
AAFP leaders point to the uncertainty of the economy and the murky future of such federal programs as the debt-to-income ratio component -- known as the "20/220 pathway" -- of the economic hardship loan deferment, which allows resident physicians to postpone paying back their school loans during the first three years of their training.
Last August, the Academy and other organizations asked the U.S. Department of Education (4-page PDF; About PDFs) to permanently restore the pathway, which was eliminated in 2007, or to provide an equivalent funding mechanism for loan deferments. To date, the department has not acted on that request.
AAFP to Redouble Reform Efforts
Calling the 2009 Match results for family medicine "disappointing," AAFP President Ted Epperly, M.D., of Boise, Idaho, told AAFP News Now, "We will be redoubling our efforts for health care and graduate medical education reform, as well as speaking powerfully to the importance of an increased primary care workforce to meet the needs of the American health care system."
Results of the National Resident Matching Program, 1997-2009, for Family Medicine Positions Offered and Filled
It's worth noting that U.S. medical students' interest in two other primary care specialties also declined this year, with 155 U.S. seniors -- 11 fewer than last year -- choosing internal medicine-primary and 241 -- seven fewer than last year -- choosing internal medicine-pediatrics.
The current medical education system also plays a role in the career choices students make, Epperly said, with many schools placing more value on applicants' test scores than on their ability to think critically. At the same time, the academic health centers where students train find they must make up for shortfalls in federal and state funding for their educational programs by relying on the income generated by highly paid subspecialists -- thus introducing a preference for subspecialist training.
"If America's medical schools continue to generate a physician workforce that is going into subspecialties, we are not meeting the needs of America's communities. America's medical schools then become part of the problem and not part of the solution of meeting America's workforce needs," said Epperly.
"The numbers are clear -- the American people and our health care system are increasingly in desperate need for primary care physicians," he added. "Under the current environment of undervaluing the vital role of primary care in our health care system, of failing to recruit students most likely to choose primary care careers, and of defaulting on appropriate support for primary care graduate medical education, the American people can look forward to an increasing crisis in their access to basic health care."
The current medical education system also plays a role in the career choices students make, Epperly said, with many schools placing more value on applicants' test scores than on their ability to think critically. At the same time, the academic health centers where students train find they must make up for shortfalls in federal and state funding for their educational programs by relying on the income generated by highly paid subspecialists -- thus introducing a preference for subspecialist training.
"If America's medical schools continue to generate a physician workforce that is going into subspecialties, we are not meeting the needs of America's communities. America's medical schools then become part of the problem and not part of the solution of meeting America's workforce needs," said Epperly.
"The numbers are clear -- the American people and our health care system are increasingly in desperate need for primary care physicians," he added. "Under the current environment of undervaluing the vital role of primary care in our health care system, of failing to recruit students most likely to choose primary care careers, and of defaulting on appropriate support for primary care graduate medical education, the American people can look forward to an increasing crisis in their access to basic health care."
Reform Efforts Demand Primary Care Foundation
The flagging interest in family medicine and other primary care specialties could not come at a worse time.
According to the AAFP's 2006 Physician Workforce Report, more than 139,500 family physicians will be needed by 2020 to help care for an ever-increasing population of older Americans. Moreover, the Obama administration has called for a stronger primary care foundation as part of its plans to reform the U.S. health care system.
During the White House health care summit held earlier this month, Epperly told President Obama that the physician workforce shortage has to be fixed so patients have access to care. Obama agreed that the nation is not producing enough primary care physicians, in part because of the costs of medical education.
While at the summit, Epperly joined a group of lawmakers and other health policymakers in discussing the need to boost the primary care workforce and how graduate medical education could be reformed to produce more primary care physicians.
A longstanding and problematic trend has been a series of substantial cuts in primary care training grants that are funded under Section 747 of Title VII of the Public Health Service Act. Section 747 is the sole federal program that provides funds to academic departments and programs to increase the number of primary care health professionals.
In a study published in the Annals of Family Medicine last fall, researchers at the AAFP's Robert Graham Center in Washington found that these grants help produce family physicians and other primary care physicians who work in community health centers and the National Health Service Corps, providing much-needed care in medically underserved areas of the United States.
Earlier this month, the Academy and four other family medicine organizations asked HHS' Health Resources and Services Administration to double the funds available for Title VII, Section 747, during the two years covered by the American Recovery and Reinvestment Act.
The Graham Center also recently released a report (102-page PDF; About PDFs) that concluded that more medical students would go into primary care if medical schools admitted students from rural and medically underserved areas and provided them with long-term experiences in primary care settings.
In addition, the report recommended that income disparities between primary care physicians and subspecialists be resolved or reduced and that more opportunities be created for students to trade debt for service.
Perry Pugno, M.D., M.P.H., director of the AAFP Division of Medical Education and a physician workforce expert, said the 2009 results demonstrate that a convergence of factors is having a decidedly negative impact on the specialty -- and on patients. "This year's Match further demonstrates that many excellent physicians are being deterred from a rewarding career in family medicine where patients and communities receive effective, equitable and efficient patient-centered care," he said.
According to the AAFP's 2006 Physician Workforce Report, more than 139,500 family physicians will be needed by 2020 to help care for an ever-increasing population of older Americans. Moreover, the Obama administration has called for a stronger primary care foundation as part of its plans to reform the U.S. health care system.
During the White House health care summit held earlier this month, Epperly told President Obama that the physician workforce shortage has to be fixed so patients have access to care. Obama agreed that the nation is not producing enough primary care physicians, in part because of the costs of medical education.
While at the summit, Epperly joined a group of lawmakers and other health policymakers in discussing the need to boost the primary care workforce and how graduate medical education could be reformed to produce more primary care physicians.
A longstanding and problematic trend has been a series of substantial cuts in primary care training grants that are funded under Section 747 of Title VII of the Public Health Service Act. Section 747 is the sole federal program that provides funds to academic departments and programs to increase the number of primary care health professionals.
In a study published in the Annals of Family Medicine last fall, researchers at the AAFP's Robert Graham Center in Washington found that these grants help produce family physicians and other primary care physicians who work in community health centers and the National Health Service Corps, providing much-needed care in medically underserved areas of the United States.
Earlier this month, the Academy and four other family medicine organizations asked HHS' Health Resources and Services Administration to double the funds available for Title VII, Section 747, during the two years covered by the American Recovery and Reinvestment Act.
The Graham Center also recently released a report (102-page PDF; About PDFs) that concluded that more medical students would go into primary care if medical schools admitted students from rural and medically underserved areas and provided them with long-term experiences in primary care settings.
In addition, the report recommended that income disparities between primary care physicians and subspecialists be resolved or reduced and that more opportunities be created for students to trade debt for service.
Perry Pugno, M.D., M.P.H., director of the AAFP Division of Medical Education and a physician workforce expert, said the 2009 results demonstrate that a convergence of factors is having a decidedly negative impact on the specialty -- and on patients. "This year's Match further demonstrates that many excellent physicians are being deterred from a rewarding career in family medicine where patients and communities receive effective, equitable and efficient patient-centered care," he said.
