First, the good news. For the third straight year, family medicine attracted more graduating medical students, according to preliminary figures released by the National Resident Matching Program (NRMP), also known as the Match. However, the gains made were smaller than in the past two years.
This year, family medicine residency programs filled 2,611 positions out of 2,764 positions offered, for a fill rate of 94.5 percent. That's only a slight improvement on last year's record-high fill rate of 94.4 percent.
In addition, 34 more family medicine positions were offered in 2012 compared with 2011, and 35 more positions were filled in 2012 compared with 2011.
A total of 1,335 U.S. seniors matched to family medicine in 2012 -- an increase of 18 seniors compared with 2011. But for the first time since 2002, fewer U.S. seniors participated in the NRMP than in the preceding year: 16,527 in 2012 versus 16,559 in 2011.
Stan Kozakowski, M.D., director of the AAFP Division of Medical Education, told AAFP News Now that because of a rule change, 2012 was the last year that any graduate medical education positions could be partially filled outside of the Match. "Next year, programs must have their positions 'all in' or 'all out' of the Match," he said.
Kozakowski also noted that the AAFP does not yet have all the critical statistics in hand. "A more complete picture of the state of family medicine residency programs will be known when an annual census is completed prior to the start of the academic year on July 1," he said.
AAFP Match data include family medicine, family medicine-psychiatry, family medicine-emergency medicine, family medicine-preventive medicine and family medicine-internal medicine programs.
Despite the fact that the 2012 numbers stayed in the positive column, AAFP President Glen Stream, M.D., M.B.I., of Spokane, Wash., expressed concern.
Family medicine's 2012 Match numbers barely increased from 2011 numbers and certainly did not indicate enough growth in the specialty to keep up with America's increasing demand for family physicians, he told AAFP News Now.
"Family medicine is the foundation of improved health care in this country," said Stream. "We must continue to promote programs that generate and sustain student interest in the specialty."
Stream noted that health system reform is under way, and initiatives such as CMS' Primary Care Incentive Program and private payer pilot projects were designed to increase payment to primary care physicians in general -- and family physicians in particular -- for delivering high-quality care in a patient-centered medical home environment.
However, that work is far from finished.
Dylan Werth opens his Match day packet as his wife, Kayla, and his parents, Lori and David Werth, look on.
According to a preliminary 2012 Match report prepared by the AAFP Division of Medical Education, the earning power of physicians who choose medical specialties other than primary care continues to overshadow primary care physician incomes.
"An analysis of the relationship between physician salaries and specialty choice found that U.S. seniors are predominantly choosing the more highly compensated specialties," said the report, adding that "the dramatic increase in the income gap between primary care and other specialties" must be appropriately addressed.
"Americans need access to primary care doctors, and the path to filling that pipeline with future family physicians is clear," said Stream. "Several things need to happen, including narrowing the income gap between primary care and other physician specialists, reforming the medical education infrastructure, changing the system that funds graduate medical education, and increasing support for programs such as the National Health Service Corps and health professions training programs."
The AAFP report suggests that a vibrant family medicine workforce depends on multiple factors, including the ability to
- recruit students to the specialty,
- train family medicine residents to provide health care within the framework of a patient-centered medical home and
- sustain family physicians in practice.
Family physicians "provide the kind of care the nation says it wants and needs," said the AAFP report. "The challenge for the future is to clearly communicate with policymakers, educators, medical students and the public that a well-trained, adequately equipped and equitably distributed family physician workforce is key to health care in the United States."
Those challenges, however, were not necessarily top of mind for at least four students at the University of Missouri-Kansas City (UMKC) School of Medicine.
UMKC confirmed that this year, 40 percent of its graduating class of 86 matched to primary care programs, including family medicine, internal medicine, pediatrics and OB-Gyn. Four students matched into family medicine.
George Harris, M.D., UMKC's assistant dean for years one and two medicine and a professor of community and family medicine, admitted that he initially was disappointed that only four students chose family medicine in 2012, down from seven in 2011. But he spoke highly of those future family physicians.
"Even though the number is small, I know the quality and caliber of the individuals who matched, and they will represent our specialty well," he said.
Enjoying the moments after Match day ceremonies are three of the four students from the University of Missouri-Kansas City School of Medicine who matched to family medicine. They are, left to right, Ruth Pitts, Allison Klapetzky and Dylan Werth, and they are shown with their professor, George Harris, M.D., at the far right. Not pictured is Kenneth Tan, of Columbia, Mo., who matched to the University of Missouri at Columbia Family Medicine Residency.
One of those students is Dylan Werth, of Lee's Summit, Mo. Werth will be joining Truman Medical Center-Lakewood Family Medicine Residency Program in Lee's Summit.
According to Werth, he knew midway through UMKC's six-year medical school program that family medicine was for him. "I enjoy getting to know patients and developing long-standing relationships with them," said Werth. "I also like being able to diagnose problems and treat them without having to send patients to outside specialists."
Another student, Ruth Pitts, of Bolivar, Mo., will join the Cox Family Medicine Residency in Springfield, Mo. Pitts discovered her enthusiasm for family medicine in high school when she shadowed a local family physician in the summer leading up to -- and then throughout -- her senior year.
"I love the continuity of care and that I can offer a wide range of services for patients," said Pitts. She's also learned that patients trust their family physicians and respect their treatment recommendations in a way that positively affects care and outcomes. "Patients feel like you have their best interests in mind," said Pitts, adding that she will enjoy the years of continuous learning that family medicine requires.
Allison Klapetzky, of Okawville, Ill., soon will be on her way to the St. Francis Hospital System Family Medicine Residency in Indianapolis.
"In the eighth grade, I knew I wanted to be a family doctor," said Klapetzky, president of the family medicine interest group at UMKC. "I embrace the womb-to-tomb philosophy of family medicine."
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