• Workforce Reform

    There must be significant reforms to physician training and delivery of health care with a strong foundation in primary care. This is essential to fulfilling the promise of providing comprehensive and effective primary care to all people of the United States, improving their health outcomes, reducing health inequities, and reducing the cost of health care. The family medicine workforce needs to grow dramatically with a composition and distribution that reflects the diversity of the population. This policy outlines principles that the AAFP will support and promulgate to accomplish these goals.


    Principle 1: Pathways to Family Medicine from All Underrepresented Communities

    The first step in providing effective healthcare to a community is to ensure that the physicians who are serving the community are representative of that community. For this diversity to exist, physicians must be recruited from their communities. Effective pathway programs that target students from groups that are underrepresented in medicine need to be developed and supported. Examples include programs that expose middle school, high school and college students to health professions, and holistic admissions processes for medical schools that level the playing field for students from underrepresented groups.


    Principle 2: Accountability for United States Medical Schools

    It is crucial to address workforce deficiencies in primary care at the medical school level. Admissions guidelines that seek to address the community need for primary care physicians to serve rural and underserved populations should be followed by all medical schools, and state-funded medical schools especially must be accountable to addressing the pressing health care needs and health inequities.


    Principle 3: Graduate Medical Education Reform

    There must be an adequate number and composition of family medicine residency positions available in all areas of the country to complete the training of physicians for all communities. In addition to the policies stated in the AAFP Graduate Medical Education Financing Policy, reform of the systems that locate residencies need to be modified to ensure that residency training sites exist in places of health professional shortage including rural and urban underserved areas.


    Principle 4: Financial Support for Family Medicine Careers

    For students considering their career choices, the debt that they may accumulate in undergraduate and medical school, paired with career salary projections that are lower compared to other medical specialties, may create a significant personal barrier to pursuing family medicine. The AAFP supports policies to decrease the cost of medical education for the learner, decrease medical student debt accumulation, and decrease the discrepancy in pay between primary care and other medical specialties. Furthermore, the AAFP encourages innovation and study of the effectiveness of existing and future systems of amelioration of debt to determine which strategies are truly effective.


    Principle 5: Training to Meet Community Needs

    Family physicians should be trained to serve population and community health needs. This training is a core tenet of family medicine residency education and prepares family physicians to navigate variations in patient, community, and population needs to improve health. Clinical training in family medicine should include accountability to community health needs. The systems and pathways that precede residency must support recruitment and training of individuals who are likely to pursue and will excel in this type of training and practice. Additionally, residency sponsoring institutions should be held accountable for encouraging residency training strategies that prepare residents to improve the health of communities rather than solely for the financial benefit of the sponsoring institution.


    Principle 6: Scope of Practice that is Broad and Adaptive

    Family physicians add value to the community and overall health system when they practice medicine to the full extent and scope of their training. The AAFP supports policies to protect the scope of practice of family physicians from systemic forces that seek to limit it including, but not limited to, financial inequity for payment of services, regressive management practices of health systems, and efforts of specialty groups. Additionally, policies need to be developed and supported to promote allowing family physicians to provide equitable care to underserved societal groups, rural communities, and other populations with inequitable health outcomes.

    (1995) (October 2023 COD)