Student Choice of Family Medicine, Incentives for Increasing

A robust family medicine workforce is critical to ensure that the American public has equitable access to appropriate and effective primary care. The American Academy of Family Physicians recognizes the multifaceted and complex factors leading to specialty choice. Therefore, the AAFP calls on entities including, but not limited to medical schools, health systems, local and federal government, health care payers, nonprofit organizations, and private industries to develop and support programs and incentives that encourage student career choice of family medicine. These programs and incentives could be financial, educational, institutional, or political in nature.

The Four Pillars for Primary Care Physician Workforce Reform – pathway (formerly named “pipeline”), process of medical education, practice transformation and payment - identify the components needed to ensure sufficient growth in the number of primary care physicians (defined as family physicians, general internists and general pediatricians). This model is used to organize and list the following program characteristics and initiatives proven to increase student choice of family medicine.

The AAFP recognizes that access to shadowing opportunities is often limited by institutional, regulatory, and operational barriers, including employer and health system policies related to compliance, liability, documentation, and productivity expectations. These barriers can restrict the ability of physicians and practices to offer shadowing experiences, even when there is interest and capacity to teach.

Early exposure to family medicine and primary care

• Develop innovative educational programs for students from elementary school through medical school that provide age-appropriate mentoring and experiential learning from high-quality primary care physician role models.
• Establish formal engagement with local and regional premedical advisors.
• Implement pre-admissions programs or other experiential programs in primary care - examples include summer experiences, shadowing, and involvement in Area Health Education Centers (AHEC), Health Careers Opportunity Program (HCOP), and HOSA Future Health Professionals.
• Address institutional, regulatory, and operational barriers that restrict ability of community physician and their practices to offer shadowing to pre- med and medical students

Medical School Admissions

• Ensure medical school admissions committees that recognize and value attributes found in primary care, appoint an adequate number of family medicine faculty as committee members, and include family physician interviewers as part of the admissions committee.
• Develop medical school admissions strategies that target students who are more likely to choose a family medicine career.
• Actively engage, recruit, and prepare students historically marginalized or excluded in medicine.

Outreach to Sustain Students’ Interest in and Choice of Family Medicine

• Supporting medical school pathways and programs for students interested in under-resourced and historically and intentionally excluded populations.
• Prioritize medical school pathways and programs that introduce and prioritize primary care, such as rural clinical pathways and AHEC Scholars program.
• Invest in family medicine student organizations (FMSO), such as family medicine interest groups (FMIG), American College of Osteopathic Family Physicians (ACOFP) student chapters, and non-family medicine-based groups that grow and diversify the family medicine workforce.
• Create FMSO that maximize influence through engaged faculty advisor(s) committed administrative staff, and collaboration with other interest groups that promote primary care and participation in leadership and engaged membership of students from all years.
• Maintain a mechanism for students to join the AAFP as student members.
• Encourage equitable and sustainable pathways for attendance at FUTURE.
• Develop longitudinal mentorship programs to connect students with family physicians throughout medical school.
• Expand opportunities to highlight family medicine's unique role and involvement in public health and advocacy efforts.

Measuring the impact of family medicine workforce development initiatives

• Create a strategic plan for student choice of family medicine within the family medicine department or division and monitor the progress.
• Establish mechanisms to measure the effectiveness and provide financial resources for initiatives that aim to increase student choice of family medicine.
• Apply quality improvement principles and practices to increase student choice of family medicine.
• Support federal and state policies that establish expectations for medical schools to produce family physicians and to accurately report their primary care physician workforce production and distribution.
• Evaluate and improve the likelihood of medical schools with a social mission and/or primary care mission graduate students that match into family medicine.

Process of Medical Education

Addressing the hidden curriculum

• Implement systemic strategies to endorse positive perceptions of family medicine and promote family physicians as leaders within the institution.
• Advance evidence-informed medical school curricula, governance and programming to increase student choice of family medicine.
• Establish a standardized system to engage with interested students following a family medicine clerkship, including regularly scheduled meetings between department chairs or faculty and medical students.
• Ensure student exposure to influential family physician leaders outside of academic family medicine settings, including through state medical societies and local AAFP chapters.
• Implement initiatives to promote the value of family medicine to non-family medicine faculty, medical school deans, and others influential leaders in the medical school and surrounding community.

Curriculum innovation

• Advocate for medical school accreditation standards set by Liaison Committee on Medical Education (LCME) or Commission on Osteopathic College Accreditation (COCA) to require early exposure to family medicine in medical education.
• Advocate for family medicine clinical experiences shown to influence specialty choice, including required clerkships, elective rotations, accelerated tracks, and longitudinal programs that allow students to experience continuity of care.
• Promote initiatives to expose students to family medicine role models and the full scope of family medicine practice across hospital-based and ambulatory settings.
• Prioritize exposure to diverse practice settings outside of the academic health centers to expose students to full-spectrum family medicine.
• Educate students about the social determinants of health (SDoH) and ensure clinical exposure to under-resourced and vulnerable patient populations, and the role that family medicine plays in screening for and identifying SDoH and connecting to resources.
• Collect meaningful family medicine clerkship evaluation data and use it to drive continuous quality improvement of the educational experience.

High-quality preceptors

• Provide resources, support, and training for family medicine departments, divisions and institutions to offer financial and professional incentives for community-based family physician preceptors.
• Strengthen recruitment, development and retention of family physician preceptors through enhanced, sustained institutional support.
• Support the development of medical school family medicine alumni networks as clinical training sites for medical students.
• Provide resources, support, and training to enable family medicine departments, divisions and institutions to offer financial and professional incentives for research opportunities in family medicine and connect learners to faculty researchers.

Adequate family medicine residency slots

• Support graduate medical education modernization proposals that protect and expand funding for family medicine residencies.
• Support initiatives to expand and fund rural training tracks.

Practice Transformation

Learners as part of interprofessional teams

• Promote integrated interprofessional education that positions students as an essential member of the care team.
• Promote initiatives to expose students to innovative family medicine practice models
• Provide institutional support for student-run free clinics with a primary care focus.

Family physicians as Leaders

• Recognize family physicians as leaders within interprofessional care teams and as health equity champions within their communities
• Enhance medical school leadership development that prepares family physicians to lead in team-based primary care.
• Ensure access to rural health and global health experiences that highlight family medicine career pathways.
• Promote student engagement in population health, community service, and advocacy at the institution and community levels.
• Support practice-based research on addressing health disparities.

Promote the value of primary care and family medicine within the healthcare system to learners, patients, and communities

• Actively promote efforts to preserve full-scope family medicine training and practice opportunities.
• Expose students to health care reform, public health, and physician workforce policies.
• Educate learners on primary care’s role in improving quality and controlling costs across the health care system.
• Support innovative primary care including quality improvement, comparative effectiveness, translational, and community-based participatory research.
• Advocate for state and federal policies that prioritize and sustain a primary care-based physician workforce.
• Define and clarify family medicine as a distinct and essential specialty within primary care.

Payment

Medical school debt

• Provide financial incentives including scholarships, tuition waivers, educational loan forgiveness and low interest loan programs for students, residents and practicing physicians who commit to family medicine. 
• Direct students to federal and state loan repayment and scholarship opportunities.
• Educate medical students and financial aid offices that family medicine is a financially viable career options, including students with high educational debt.

Payment for family physicians

• Advocate for payment reform that appropriately values primary care.
• Support faculty engagement in advocacy efforts to address the physician payment gap.
• Advocate for the sustainability of a variety of family medicine practice models.

(2006) (July 2026 BOD)