2014: Year in Review

Strong Match, Advances in Workforce Reform Top Education Gains Last Year

January 07, 2015 04:02 pm News Staff

When it came to education and training issues important to family medicine in 2014, rising Match numbers and progress on both the workforce and graduate medical education reform fronts were among the highlights. Here's a look at some of the key events from the past year.

[Newly matched family medicine resident Catherine Louw and her fiance Ryan Coe]

Catherine Louw at the University of Washington School of Medicine, Seattle, celebrates with her fiancé, Ryan Coe, after learning she'll soon head to the University of North Carolina at Chapel Hill Family Medicine Residency.

Match Results Looking Up

In February, AAFP News reported that more osteopathic physicians matched to family medicine than any other medical specialty in the recently completed American Osteopathic Association (AOA) Intern/Resident Registration Program, which pairs graduating osteopathic physicians with residency programs nationwide.

When the results were tabulated, family medicine filled 519 of 880 open positions in the 2014 osteopathic Match.

The good news continued in March, when results of the 2014 National Resident Matching Program, commonly known as the Match, highlighted the same sort of positive trend for allopathic family medicine programs. For the fifth straight year, the number of medical students choosing family medicine ticked higher than the previous year.

Specifically, 3,000 students, including both U.S. medical school graduates and international medical graduates, chose family medicine; that figure represents a 2 percent increase (62 more positions filled) compared with the 2,938 family medicine spots filled in 2013. Moreover, of this year's total, 1,416 U.S. seniors matched to family medicine; that's 42 more than in 2013, or a 3 percent increase.

Finally, a total of 70 more family medicine residency positions were offered in 2014 compared with 2013 (3,132 versus 3,062), yet the higher number of students matching into the specialty maintained the same fill rate of 96 percent.

Filling the Primary Care Pipeline

Those numbers are especially encouraging given the ongoing need to feed the primary care workforce pipeline. Nowhere is this need felt more keenly than in the nation's more remote communities, where tens of millions of Americans rely on rural health professionals for their care.

In January, a Capitol Hill forum on rural health care highlighted the shortages of primary care physicians and other health professionals in rural areas for policymakers and other interested parties. Panelists who spoke during the event, which was sponsored by the Robert Graham Center on Policy Studies in Family Medicine and Primary Care, pointed to the success of the Rural Training Track Program and stressed the need for continued support of this program.

According to panelist Amy Elizando, M.P.H., vice president of program services for the National Rural Health Association in Washington, 62 million Americans rely on rural health care professionals. Another panelist, former AAFP President Ted Epperly, M.D., of Boise, Idaho, pointed to a number of strategies needed to grow the U.S. rural physician workforce, including a focus on the kindergarten-to-12th-grade pipeline. Students who would make good primary care physicians need to be identified and encouraged early, particularly those in rural areas. In addition, students need shadowing and mentoring opportunities, loan repayment programs, and recruitment efforts that are aimed at retaining them in primary care, said Epperly.

[Stock photo of physician with medical students in classroom]

It's a problem with which the AAFP is all too familiar. In recognition of this very dilemma, the Academy released a policy document in March that outlines how the nation could resolve its chronic shortage of family physicians by implementing targeted strategies that recognize and promote the value f primary care.

The policy paper, titled "Family Physician Workforce Reform: Recommendations of the American Academy of Family Physicians," lays out a strategic plan regarding how to increase the annual production of new family physicians by an average of about 65 physicians each year through 2025. Doing so would move the needle on the number of practicing family physicians from 3,500 today to 4,475 in about a decade.

Policy experts have for years struggled with the problem of trying to match the nation's physician needs with the actual physician workforce the graduate medical education (GME) system churns out. This past year marked some key advances in efforts to achieve that goal.

Need for GME Reform

In July, the Institute of Medicine (IOM) released its long-awaited critique of the nation's GME system. Specifically, the 21-member IOM committee, convened at the behest of the Josiah Macy Jr. Foundation in 2012, reviewed how U.S. GME is both governed and financed.

In their final report,(books.nap.edu) the authors estimated that in 2012 alone, public financing of GME totaled about $15 billion, with two-thirds of that amount -- or nearly $10 billion -- coming from Medicare coffers.

"Although the scale of government support for physician training far exceeds that for any other profession, there is a striking absence of transparency and accountability in the GME financing system for producing the types of physicians that the nation needs," wrote the authors.

Then, in September, the AAFP released its own proposal to reform GME in the United States to ensure that, among other things, teaching institutions don't prioritize funding for subspecialty training at the expense of primary care training programs.

After laying out the Academy's plan for overhauling the U.S. graduate medical education system during a Capitol Hill press event, (then) AAFP Board Chair Jeff Cain, M.D., takes a question from the audience.

During a Capitol Hill press event, the AAFP unveiled a five-point plan included in the proposal(7 page PDF) that would, among other things, significantly change the way GME is financed. Specifically, the proposal urges policymakers and stakeholders to take the following actions:

  • Limit direct GME and indirect medical education payments (money paid to hospitals to subsidize indirect expenses associated with resident training) to training for "first-certificate" residency programs -- that is, those that train physicians in one of 25 recognized specialty areas such as family medicine, pediatrics, psychiatry, and internal medicine and are foundational to additional subspecialty training.
  • Establish primary care thresholds and "maintenance of effort" requirements that apply to all sponsoring institutions and teaching hospitals that currently receive Medicare and/or Medicaid GME financing.
  • Require all sponsoring institutions and teaching hospitals that seek new Medicare- and Medicaid-financed GME positions to meet primary care training thresholds as a condition of that expansion.
  • Align financial resources with population health care needs through a reduction in indirect medical education payments and allocation of those resources to support innovation in GME.
  • Fund the National Health Care Workforce Commission.

Regarding that final item, the AAFP noted in a supplement to its proposal(2 page PDF) that although creation of the commission, a 15-member panel that would review current and projected health care workforce supply and demand, had been mandated as part of the Patient Protection and Affordable Care Act, it had not yet been funded by Congress.

Noting a lack of accountability in outcomes from a 50-year old GME system that served the country well for decades but has not kept pace with demographic and population changes, (then) AAFP Board Chair Jeff Cain, M.D., of Denver, told attendees at the Sept.15 event, "We need to apply the same evidence-based principles we apply in medicine to medical education."

Academy EVP and CEO Douglas Henley, M.D., who also spoke during the event, underscored Cain's comments.

"There are eight deadly words in our vocabulary: 'We have always done it that way before,'" Henley said. "We've been financing GME the same way for the last 50 years, and it's time to move beyond the status quo.

"We need to create a physician workforce with a primary care foundation because that's what the country needs."

Other Professional Development Issues

After many months of discussion and negotiation, leaders of the U.S. allopathic and osteopathic medical communities announced early last year that they plan to transition to a single GME accreditation system.

In a joint press release issued Feb. 26, the Accreditation Council for Graduate Medical Education (ACGME), the AOA and the American Association of Colleges of Osteopathic Medicine said the move to a single system would help ensure that Americans have access to safe, high-quality health care.

Obviously, the groups noted, the move to a single accreditation system will not happen overnight; rather, the new system will be phased in over a five-year period extending from July 1, 2015, to June 30, 2020. During the transition process, however, AOA-accredited programs will be able to apply to receive ACGME recognition and accreditation.

The 2014 National Conference of Family Medicine Residents and Medical Students set new attendance records, with 3,886 people attending the Aug. 7-9 event in Kansas City, Mo., including 1,211 medical students and 1,092 family medicine residents.

[Deborah Clements leads panel discussion with Abbas Hyderi and Lilia Cardenas]

FPs participating in a panel discussion during the 2014 National Conference of Family Medicine Residents and Medical Students talk about the specialty's many career options.

During the conference, delegates to the National Congress of Family Medicine Residents and National Congress of Student Members chose new leaders to represetlinent them throughout the coming year. In addition, after joining with other attendees in considering a host of issues important to residents and medical students -- such as direct primary care, rural health issues and student debt -- Congress participants then voted on resolutions regarding those topics.

And finally, if four medical students at Harvard University in Boston have anything to say about it, many more students could soon be flocking to the family medicine banner.

In November, Harvard medical students Diana Wohler, Mark Wu, Rachael Rosales and Ashley Shaw put together a town hall meeting designed to foster discussion among students, residents, faculty and others about how to develop robust family medicine educational opportunities for both students and faculty.

Speakers at the event included Josh St. Louis, M.D., a first-year family medicine resident at the Lawrence Family Medicine Residency in Lawrence, Mass., and Kirsten Meisinger, M.D., a family physician and regional medical director for the Cambridge Health Alliance.

Primary care internist Russell Phillips, M.D., director of Harvard Medical School's Center for Primary Care, told AAFP News at the time that the school was in the midst of creating new medical school curriculum and said the center is working with faculty to create a foundational experience in primary care for all students.

So, will Harvard Medical School someday boast a department of family medicine?

"I think it will happen," said Phillips, although he cautioned that it likely would be a five-to-10 year process.

"It takes time, and that's not meant to devalue any of the work that's going on, but just to recognize the complexity of creating new departments at a place like Harvard Medical School," he said.