Authors of an article in the October 2012 Family Medicine summed up their opinion of patient access to primary care in America in their opening paragraph: "A crisis in access to first-contact, comprehensive and coordinated medical care is occurring in the United States," wrote the authors. Bottom line, the family medicine workforce is not growing at a rate sufficient to meet the country's needs.
The authors, who all are staff members in the AAFP's Division of Medical Education, said in the article "Results of the 2012 National Resident Matching Program: Family Medicine(www.stfm.org)" that family medicine is the key to the distribution of equitable care. Although about one-quarter of U.S. allopathic medical students -- a force of more than 20,000 -- are AAFP members, fewer than nine percent of those students choose family medicine.
Overall, family medicine residency programs offered 2,764 first-year positions in 2012, an increase of 34 from 2011, and they had a fill rate of 94.5 percent or 2,611 spots filled, an increase of 35 from 2011.
The article represents the 31st annual report on the National Resident Matching Program (NRMP) that is provided by the AAFP and that specifically looks at how many graduates of allopathic medical schools choose family medicine residencies.
The report compares 2011 and 2012 Match statistics and is intended to provide a snapshot of the makeup of residents entering programs in July 2012. For example, the authors found that
- AAFP authors of a report on the 2012 Match say the family medicine workforce is not growing fast enough to meet the country's needs.
- Medical schools can help ease the primary care shortage by admitting students who are most likely to choose a career in primary care.
- Some of the medical schools with the highest percentage of students matching to family medicine have the smallest medical school class sizes.
- in 2012, the NRMP offered the greatest number of residency positions in its history with 22,240 open positions and a fill rate of 20,940;
- 14,359 of those slots were filled with U.S. seniors;
- 1,335 U.S. seniors matched into family medicine residencies, or 18 more than in 2011;
- 8.1 percent of all U.S. seniors participating in the Match chose family medicine compared to 8 percent in 2011; and
- 48.3 percent of family medicine positions offered in 2012 were filled with U.S. seniors with an M.D. degree.
Furthermore, 1,276 other graduates matched to family medicine in 2012, including 325 graduates of colleges of osteopathic medicine, 350 non-U.S. citizens educated internationally, and 518 U.S. citizens educated internationally.
Geographically, the Mountain region of the country had the highest filled rate in 2012 at 98.6 percent. The East South Central region reported the lowest fill rate at 88.7 percent.
The authors noted that again in 2012, an increasing number of D.O. physicians chose family medicine. The report showed that graduates of colleges of osteopathic medicine filled 706 first- year positions (20.2 percent) in July 2012 compared to 633 (18.3 percent) in 2011 and 599 (18.1 percent) in 2010.
The authors said those numbers likely would continue to rise because of the growing enrollment numbers at current and newly-accredited osteopathic medical schools in conjunction with an increase in the number of dually accredited family medicine residency programs.
There were just 26 such programs in 2003 compared to more than 113 in 2012.
"Some of the most interesting statistics are centered on the D.O. graduates," said lead author Wendy Biggs, M.D., assistant director in the AAFP's Medical Education Division. "By 2016, enrollment in osteopathic medical schools will be almost triple what it was 10 years ago."
Biggs noted that as the numbers of D.O. physicians entering residency programs increase, the number of international medical graduates (IMGs) gaining residency spots in family medicine will decrease proportionately. "In the next few years, we may see pressure building in this area and a resulting decrease of admissions of IMGs into family medicine residency programs," said Biggs.
IMGs -- both U.S. citizens and non-citizens -- currently account for about 25 percent of family medicine residency positions.
A second article by the same set of authors and titled "Entry of U.S. Medical School Graduates Into Family Medicine Residencies: 2011-2012(www.stfm.org)" examines, among other things, the role of medical schools in producing enough primary care physicians to meet the country's needs.
Biggs pointed out the social accountability factor of medical school admission policies. "We know what kind of people go into family medicine," said Biggs. "If the mission of medical schools is to serve the health of the public, then they need to admit more students who fit that primary care mold."
A similar theme was picked up in an accompanying editorial titled "Medical School Graduates Entering Family Medicine: Increasing the Overall Number(www.stfm.org)." The family physician authors of the editorial point out that even the medical schools that represent the top-tier producers of students entering family medicine have seen nearly a 50 percent reduction in those numbers compared to just 10 years ago.
For example, the University of Minnesota went from 62 students entering family medicine residencies in 1999 to just 26 in 2011. The University of Kansas went from 54 to 23, the University of Iowa went from 45 to 27, and Wayne State University went from 43 to 24.
The editorial explains that the impact some of the schools with the highest percentages of students entering family medicine have on the overall workforce issue is diluted because many of those high-percentage schools have smaller class sizes.
For instance, in 2011, the University of North Dakota had one of the nation's highest percentages (21.8 percent) of students entering family medicine with 12 of its 55 graduates doing so. On the other hand, the University of Indiana had a percentage (9.9 percent) just slightly above the national average, but because the school has one of the largest class sizes in the country at 303, it added 30 family medicine residents to the 2011 total.
The authors opined that to increase the family medicine workforce to numbers sufficient to meet the nation's needs, the medical schools producing the fewest number of students entering family medicine need to be brought up to the level of the best performing schools.
Those high-performing medical schools currently account for close to 20 percent of the nation's medical school graduates who choose family medicine. "In the current environment of reduced student interest in primary care, it is important to identify the reasons that some schools have been able to be more successful than others, and hopefully, to replicate their success," concludes the editorial.