AAFP Statement: Medical Education, US Health Care System Need to Rebalance America’s Physician Workforce

Wednesday, February 18, 2009

Statement Attributable to:
Ted Epperly, MD
American Academy of Family Physicians

America is reinvesting in medical education. We are building nine new medical schools and expanding the class size in all but 18 of 126 existing schools. Since 2000, we have seen the completion of nine osteopathic schools.

Such an unprecedented expansion offers an opportunity to rebalance the U.S. physician workforce and ultimately ensure affordable access to high quality health care for all Americans.

Although there are many things with which we agree in this report, there is one item that would have strengthened the impact of the Macy Report. One of the most important elements of the medical education system is the medical school’s role in helping create a balanced medical workforce to meet society’s health care needs. Unfortunately, America’s medical schools have gotten seriously out of balance in aligning workforce production with societal need. The reason for America’s mediocre health care outcomes – when compared with the rest of the world and despite having the most expensive health care enterprise in the world – is largely due to the lack of a sufficient number of medical students interested in primary care. As reforms go forward to expand health care coverage for the people of America, we must have a parallel effort to create a larger workforce of primary care physicians to ensure that these patients have access to affordable, timely and high quality primary health care.

The underlying causes of not having enough primary care physicians are multifactorial to be sure, but the fact that this problem is not addressed more thoroughly in this report represents a missed opportunity to re-establish a balanced national medical workforce. As our country stands on the threshold of expanding medical education for the first time in thirty years, we must collectively do all that is possible to help design a workforce that will meet our country’s growing health care needs and ensure access to a high quality health care system.

This report and its recommendations are a good start to ensure the right balance among medical specialties and help improve patients’ access to efficient, effective, and equitable health care in the right place and at the right time. They reiterate many of the research findings and the policies advocated by family physicians. The AAFP has called for:

  • broadening the qualifications for medical school admission and reducing reliance on standardized tests, grade point averages and undergraduate course requirements in selecting applicants;
  • employing a comprehensive set of admission criteria that will attract and support students who have both the intellectual capacity for medicine and a commitment to serving others;
  • actively recruiting students from a diverse pool of applicants, including those from rural and medically underserved areas;
  • educating medical students “who are prepared to choose careers as generalists and specialists in adequate numbers to address the full range of patient needs in all geographic regions of the country;” and
  • fostering greater inter-professional teamwork and collaboration.

Like the Macy report, the AAFP has called on the federal government to support additional medical student debt forgiveness programs such as the National Health Service Corps and to increase investment in Title VII of the Public Health Service Act to support innovations in primary care education and delivery.

Family physicians value the expertise of their subspecialist colleagues. At the same time, we recognize that a medical education system that evolved in the early to mid-20th century and relies on episodic and fragmented care will not meet the needs of today’s patients that calls for integrated and coordinated care.

The U.S. health care system must have a physician workforce with expertise in the whole person, in managing multiple and simultaneous chronic conditions, and in ensuring that all health professionals involved in the care of patients are working together as a team. These elements comprise the heart of primary care in general … and family medicine in particular.

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Founded in 1947, the AAFP represents 136,700 physicians and medical students nationwide. It is the largest medical society devoted solely to primary care. Family physicians conduct approximately one in five office visits -- that’s 192 million visits annually or 48 percent more than the next most visited medical specialty. Today, family physicians provide more care for America’s underserved and rural populations than any other medical specialty. Family medicine’s cornerstone is an ongoing, personal patient-physician relationship focused on integrated care.  To learn more about the specialty of family medicine, the AAFP's positions on issues and clinical care, and for downloadable multi-media highlighting family medicine, visit www.aafp.org/media. For information about health care, health conditions and wellness, please visit the AAFP’s award-winning consumer website, www.familydoctor.org(familydoctor.org).