Turning the ship on the shortage of family physicians: Changing graduate medical education, filling the family physician pipeline

Graduate medical education funding today determines whether patients will have a primary care physician when they need one tomorrow. But our medical education system relies on a market-based system to train future doctors. The result: seven out of 10 American physicians are subspecialists at a time when the U.S. struggles with a primary care physician shortage.

How did that happen? GME funding goes to teaching hospitals, which allocate funds to subspecialty residency programs that generate more income. In short, academic health centers have a financial incentive to emphasize subspecialty training in tertiary hospitals instead of primary care training in the community.

But research, such as the study described in “Teaching Health Centers Help Resolve Primary Care Physician Shortage in Underserved Areas(www.graham-center.org),” proves medical students choose primary care and family medicine when their medical school curriculum exposes them to community-based primary care practices. Family medicine residents who train in community-based clinics are more likely to practice in underserved areas.

The system needs to change. The highly successful Teaching Health Center GME program trains residents in primary care in community settings. And more than eight in 10 of their graduates practice primary care; more than half practice in underserved communities.

AAFP’s Graduate Medical Education Financing Policy would increase the number of people choosing primary care medicine without increasing the cost of funding for residency training. Among the recommendations:

  • Provide permanent and adequate funding for Teaching Health Centers—community-based primary care residency programs that meet the needs of the communities they serve. 
  • Limit GME funding only for what are known as first-certificate programs—training for general internal medicine, family medicine and general pediatrics.

Teaching Health Centers are Integral to Future Access to Care
Ensuring that Americans have access to a primary care physician remains one of the foremost challenges in U.S. health care policy. A major part of the solution is the highly successful Teaching Health Center Graduate Medical Education Program. Currently, 57 teaching health centers are training 700 residents in primary care residency programs across 24 states and the District of Columbia.

Video: Teaching health centers from the patients’ and residents’ perspective

 

Legislation that will help build the primary care physician workforce:

AAFP recommendations(158 KB PDF) that Congress reform Medicare GME financing to address inequities, improve accountability and train more family physicians.

AAFP testimony to House Energy and Commerce Subcommittee on Health supporting continued funding of the Teaching Health Center GME Program.

S. 304: “Training the Next Generation of Primary Care Doctors Act,”(www.congress.gov) would extend the Teaching Health Center Graduate Medical Education Program for five years, authorize adequate and sustainable funding for existing residency programs, and support expansion into rural and underserved communities.

  • AAFP letter to Sens. Susan Collins, Jon Tester, Shelley Moore Capito and Doug Jones announcing support of the “Training the Next Generation of Primary Care Doctors Act.” January 30, 2019.
  • AAFP Statement for the Record to the Senate Health, Education, Labor, and Pensions Committee Hearing Access to Care: Health Centers and Providers in Underserved Communities, January 29, 2019.
  • Coalition statement: Physicians, Medical Educators, Community Health Centers Strongly Support Training the Next Generation of Primary Care Doctors Act of 2019, February 2, 2019. 

S. 289: “Rural Physician Workforce Production Act of 2019”(www.congress.gov) would provide new robust financial incentives for rural hospitals (including critical access hospitals) to provide the training opportunities needed by the communities they serve. These financial incentives also would extend to urban hospitals, for the specific purpose of growing the number of residents they train in “rural training tracks.”

  •  AAFP letter to Sen. Cory Gardner announcing support for the “Rural Physician Workforce Production Act of 2019,” February 4, 2019.  

H.R. 1358: "Advancing Medical Resident Training in Community Hospitals Act"(www.congress.gov) would change Medicare graduate medical education payment rules to allow the establishment of critical new residency programs in communities facing physician shortages, thereby improving access for patients and resulting in better training opportunities for residents.

  • AAFP letter(1 page PDF) to Rep. Ron Kind announcing support of the "Advancing Medical Resident Training in Community Hospitals Act," April 19, 2019.