Researchers from the Health Resources and Services Administration recently explored a topic of great interest to the AAFP: the nation's growing demand for primary care physicians.
Authors of an article titled "Where Do Physicians Train? Investigating Public and Private Institutional Pipelines,"(content.healthaffairs.org) published in the May 2015 issue of Health Affairs, wrote in their introduction, "Where a physician is educated -- in a public or a private institution -- affects his or her practice choices, including the likelihood of choosing a career in primary care."
Presenting the Facts
First and foremost, the United States is expected to face a shortage of some 20,400 primary care physicians by 2020, said the authors.
They presented statistics that compared public and private medical schools in terms of
- number of graduates in 2010: public, 10,946 vs. private, 9,591;
- cost of attendance in 2013-2014: public, $187,400 vs. private, $264,00;
- amount of debt at graduation in 2013-2014: public, $155,000 vs. private, $180,000; and
- percentage of graduates choosing primary care specialties from 1997 to 2006: public, 28.8 percent vs. private, 24.3 percent.
- A new report from the Health Resources and Services Administration that focused on physician pipeline issues found that medical students who train in public institutions are more likely to pursue primary care careers.
- Authors also concluded that physicians trained in rural areas tend to practice in rural areas.
- The AAFP contends that more primary care residency positions are needed to curb the nation's primary care shortage.
Authors also pointed out that previous research indicated students educated in private-sector institutions -- as well as those with a heavier student debt loan -- were "less likely to choose to practice in critically needed primary care specialties."
On the other hand, "Public medical schools with primary care missions tend to produce more generalist physicians and people who ultimately practice in underserved communities," they wrote.
One piece of good news is that the number of medical schools is growing; in fact, 16 new medical schools -- both allopathic and osteopathic -- have opened or will open between 2002 and 2018. The uptick in institution numbers means the availability of an additional 4,861 first-year student positions during that time period.
Researchers also noted regional differences in the location of public and private schools; states in the West, South and Central regions trained physicians primarily in public schools, whereas the Northeast region trained 69.5 percent of medical students in private schools.
"Even more compelling is the fact that the fourteen most rural states train 75 percent of their physicians in public institutions," said the authors.
Authors concluded that the majority of U.S.-trained physicians earned degrees in public-sector institutions and called these institutions the "primary pipeline" for educating physicians.
They noted the underlying importance of the fact that the most rural of states graduated more physicians from public institutions. "Previous research has shown that where physicians train can help determine not only where they practice, but also their future specialty," said the authors.
"Physicians trained in rural areas tend to practice in rural areas."
Researchers said their analysis also confirmed that physicians trained in public institutions were more likely to choose primary care careers than students who attended private medical schools.
Finally, concluded the authors, "Public institutions receive considerable state funding to serve their communities. Thus, states have a significant interest in ensuring that the academic institutions practice social accountability and provide a return on the states' investment."
AAFP's Pipeline Position
For its part, the AAFP continues to argue that the construction of additional medical schools alone won't be enough to curb the nation's future primary care shortage.
For instance, on March 3, in response to new physician workforce projections released by the Association of American Medical Colleges, AAFP President Robert Wergin, M.D., of Milford, Neb., said in a media statement, "We can count on our medical schools to produce well-trained physicians. However, without additional residency training positions, we won't make significant progress on increasing our country's primary care physician workforce."
He added that building community-based residency training sites -- as opposed to training residents in tertiary academic health center hospitals -- was a promising approach.
"These community-based programs both attract medical students who want to practice family medicine and help address the maldistribution of physicians," said Wergin.
Also in March, authors of research published in the Annals of Family Medicine mirrored the AAFP's stance on increasing residency slots.
Researchers projected the United States would face a shortage of 33,000 primary care physicians by 2035; they suggested the addition of 1,700 primary care residency positions to alleviate the shortfall.
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