New Report Takes In-depth Look at Reasons Behind Low Level of Student Interest in Family Medicine
By News Staff
Family medicine faces numerous challenges in the next generation, including public perception of the specialty, how family medicine practices are organized, how the specialty is treated in academia and how FPs are remunerated, according to an article in the September issue of Family Medicine.
"Results of the 2009 National Resident Matching Program: Family Medicine," (11-page PDF; About PDFs) offers an in-depth examination of the results of the 2009 residency match and notes that the results "reflect a persistently low level of student interest in family medicine residency training in the United States."
"The (family medicine) discipline faces clearly identified challenges as it prepares for the next generation of care: clearly communicating the specialty of family medicine to the public, organizing individual practices into a recognized brand, challenging the disrespectful climate of academia, enhancing reimbursement and communicating the attractiveness of a career in family medicine," say the article's authors, including Perry Pugno, M.D., M.P.H., director of the AAFP Division of Medical Education, and Amy McGaha, M.D., assistant director of the division.
According to the article, 75 fewer positions in family medicine residency programs were filled through the 2009 National Resident Matching Program, or NRMP, compared with the 2008 residency match. Moreover, 89 fewer U.S. seniors filled family medicine residency slots in 2009 than in the previous year.
Meanwhile, the article notes, only 18 fewer positions were filled in primary care internal medicine, with 11 fewer U.S. seniors choosing this specialty. One additional position was filled in pediatrics-primary care, with three more U.S. seniors selecting this as their specialty, and 13 additional positions were filled in combined internal medicine-pediatrics programs, although seven fewer U.S. seniors entered these programs than in 2008.
"The (family medicine) discipline faces clearly identified challenges as it prepares for the next generation of care: clearly communicating the specialty of family medicine to the public, organizing individual practices into a recognized brand, challenging the disrespectful climate of academia, enhancing reimbursement and communicating the attractiveness of a career in family medicine," say the article's authors, including Perry Pugno, M.D., M.P.H., director of the AAFP Division of Medical Education, and Amy McGaha, M.D., assistant director of the division.
According to the article, 75 fewer positions in family medicine residency programs were filled through the 2009 National Resident Matching Program, or NRMP, compared with the 2008 residency match. Moreover, 89 fewer U.S. seniors filled family medicine residency slots in 2009 than in the previous year.
Meanwhile, the article notes, only 18 fewer positions were filled in primary care internal medicine, with 11 fewer U.S. seniors choosing this specialty. One additional position was filled in pediatrics-primary care, with three more U.S. seniors selecting this as their specialty, and 13 additional positions were filled in combined internal medicine-pediatrics programs, although seven fewer U.S. seniors entered these programs than in 2008.
Report Offers Insight on Attributes of U.S. Graduates Entering Family Medicine Residencies
Of the 16,336 students who graduated from medical schools accredited by the U.S. Liaison Committee on Medical Education, or LCME, between July 2007 and June 2008, graduates of publicly funded schools were more likely to be family medicine residents in October 2008 than those who graduated from private schools, says a new report.
That was one of the findings cited in "Entry of U.S. Medical School Graduates Into Family Medicine Residencies: 2008-2009 and 3-year Summary," (12-page PDF; About PDFs) the AAFP's 28th report analyzing the percentage of U.S. medical school graduates entering family medicine residency programs. The article appears in the September issue of Family Medicine.
Overall, 8.2 percent of graduates of LCME-accredited medical schools from July 2007 to June 2008 were first-year family medicine residents in 2008, according to the article. That's a slight decrease from the percentages in 2007 (8.3 percent) and 2006 (8.5 percent).
Nearly 10 percent of graduates from publicly funded LCME-accredited medical schools were first-year family medicine residents in October 2008 compared with only 5.6 percent of private school graduates.
The AAFP report also found that the West North Central and the Mountain regions reported the highest percentage of medical school graduates who were first-year family medicine residents in October 2008, at 12.4 percent and 11.4 percent, respectively. The New England (6.3 percent) and Middle Atlantic (5.5 percent) regions reported the lowest percentages.
Slightly more than 45 percent of U.S. medical school graduates who were first-year family medicine residents in October 2008 entered a program in the same state as where they graduated from medical school.
Two LCME-accredited medical schools led the pack in the percentage of graduates who became first-year family residents in 2008: the University of North Dakota, Grand Forks, with 25.4 percent, and Texas A&M University, College Station, at 21.3 percent. The University of North Dakota also had the highest three-year average, at 20.3 percent.
The article's authors point out that colleges of osteopathic medicine also contributed significant percentages of graduates to family medicine residencies, most notably the Arizona College of Osteopathic Medicine of Midwestern University, Glendale, with slightly more than 27 percent.
That was one of the findings cited in "Entry of U.S. Medical School Graduates Into Family Medicine Residencies: 2008-2009 and 3-year Summary," (12-page PDF; About PDFs) the AAFP's 28th report analyzing the percentage of U.S. medical school graduates entering family medicine residency programs. The article appears in the September issue of Family Medicine.
Overall, 8.2 percent of graduates of LCME-accredited medical schools from July 2007 to June 2008 were first-year family medicine residents in 2008, according to the article. That's a slight decrease from the percentages in 2007 (8.3 percent) and 2006 (8.5 percent).
Nearly 10 percent of graduates from publicly funded LCME-accredited medical schools were first-year family medicine residents in October 2008 compared with only 5.6 percent of private school graduates.
The AAFP report also found that the West North Central and the Mountain regions reported the highest percentage of medical school graduates who were first-year family medicine residents in October 2008, at 12.4 percent and 11.4 percent, respectively. The New England (6.3 percent) and Middle Atlantic (5.5 percent) regions reported the lowest percentages.
Slightly more than 45 percent of U.S. medical school graduates who were first-year family medicine residents in October 2008 entered a program in the same state as where they graduated from medical school.
Two LCME-accredited medical schools led the pack in the percentage of graduates who became first-year family residents in 2008: the University of North Dakota, Grand Forks, with 25.4 percent, and Texas A&M University, College Station, at 21.3 percent. The University of North Dakota also had the highest three-year average, at 20.3 percent.
The article's authors point out that colleges of osteopathic medicine also contributed significant percentages of graduates to family medicine residencies, most notably the Arizona College of Osteopathic Medicine of Midwestern University, Glendale, with slightly more than 27 percent.
According to the article's authors, the 2009 NRMP results suggest that although "interest in family medicine experienced a slight increase in the number of students choosing the specialty last year (from 2,313 in 2007 to 2,404 in 2008), overall interest in primary care careers continues to decline."
According to the authors, many forces influence medical student career choices, including
According to the authors, many forces influence medical student career choices, including
- students' perceptions of the demands, rewards and prestige of the specialty;
- uncertainty surrounding the health care environment;
- lifestyle issues;
- advice from medical school leaders; and
- faculty role models.
This year, the authors note, the nation's struggling economy appears to have played an especially significant role.
Specific factors that appear to dissuade medical students from choosing family medicine are medical school indebtedness -- which now averages about $155,000 at graduation -- and medical school infrastructure, including the absence of a family medicine department, a low proportion of faculty who are family physicians and the lack of clinical clerkships in family medicine.
Another factor is the widening income gap between primary care physicians and subspecialists, which "threatens the development and maintenance of a healthy primary care base in the United States," according to the article.
On a positive note, say the authors, all but 11 U.S. medical schools have family medicine departments, more than 80 percent of medical schools offer clinical clerkships in family medicine, and opportunities for family medicine elective experiences are on the upswing.
Interestingly, more medical students overall are expressing an interest in global health activities and actively participate in international health electives. This could be good news for family medicine, according to the article, which says, "Family medicine's broad scope of training and focus on public health uniquely prepares physicians to practice global health in austere and underserved communities.
"Early evidence demonstrates that offering an international health elective may also have a positive impact on residency program recruitment," the article says.
Still, despite the AAFP's adoption of an evidence-based portfolio of interventions to address flagging student interest, "sustained improvement in interest (in family medicine) by U.S. seniors remains elusive," say the authors. Efforts to spark student interest in the specialty must be redoubled, they note, so the need for primary care physicians in the United States can be met.
The authors recommend evaluating current family medicine programs and looking for more innovative initiatives to boost student interest. In addition, predoctoral program directors, family medicine interest group faculty advisers, residency directors, department chairs and family medicine organizations should pursue opportunities for collaboration.
Specific factors that appear to dissuade medical students from choosing family medicine are medical school indebtedness -- which now averages about $155,000 at graduation -- and medical school infrastructure, including the absence of a family medicine department, a low proportion of faculty who are family physicians and the lack of clinical clerkships in family medicine.
Another factor is the widening income gap between primary care physicians and subspecialists, which "threatens the development and maintenance of a healthy primary care base in the United States," according to the article.
On a positive note, say the authors, all but 11 U.S. medical schools have family medicine departments, more than 80 percent of medical schools offer clinical clerkships in family medicine, and opportunities for family medicine elective experiences are on the upswing.
Interestingly, more medical students overall are expressing an interest in global health activities and actively participate in international health electives. This could be good news for family medicine, according to the article, which says, "Family medicine's broad scope of training and focus on public health uniquely prepares physicians to practice global health in austere and underserved communities.
"Early evidence demonstrates that offering an international health elective may also have a positive impact on residency program recruitment," the article says.
Still, despite the AAFP's adoption of an evidence-based portfolio of interventions to address flagging student interest, "sustained improvement in interest (in family medicine) by U.S. seniors remains elusive," say the authors. Efforts to spark student interest in the specialty must be redoubled, they note, so the need for primary care physicians in the United States can be met.
The authors recommend evaluating current family medicine programs and looking for more innovative initiatives to boost student interest. In addition, predoctoral program directors, family medicine interest group faculty advisers, residency directors, department chairs and family medicine organizations should pursue opportunities for collaboration.
Related ANN Coverage
Fewer Medical Students Choose Family Medicine in 2009 Match
Shaky Economy, Concerns About Indebtedness Are Factors, Say AAFP Leaders
(3/19/2009)
Medical Schools Can Play Role in Boosting Student Interest in Primary Care, Says Report
But Income Disparities Still Affect Student Choices
(3/11/2009)
More From AAFP
National Resident Matching Program
Strolling Through the Match 2008-2009
(63-page PDF; About PDFs)
Study of Factors Influencing Medical Students in Their Choice of Family Practice as a Specialty (Arizona Study)
Fewer Medical Students Choose Family Medicine in 2009 Match
Shaky Economy, Concerns About Indebtedness Are Factors, Say AAFP Leaders
(3/19/2009)
Medical Schools Can Play Role in Boosting Student Interest in Primary Care, Says Report
But Income Disparities Still Affect Student Choices
(3/11/2009)
More From AAFP
National Resident Matching Program
Strolling Through the Match 2008-2009
(63-page PDF; About PDFs)
Study of Factors Influencing Medical Students in Their Choice of Family Practice as a Specialty (Arizona Study)
