Reduced Student Exposure to FM Poses Threat to Workforce

Having a successful Match for family medicine, in a year interrupted by the COVID-19 pandemic, has been an achievement in the face of exceptional challenges. However, the challenge is not over yet, and the impact of the pandemic may be felt in the coming years.

The America Needs More Family Doctors: 25x2030 Collaborative is being supported by eight national organizations — including the AAFP — that represent family medicine and by the National Area Health Education Centers Organization. The collaborative set a goal of raising the percentage of U.S. medical students (both allopathic and osteopathic) who choose family medicine as their specialty from the current 12% to a goal of 25% by 2030.

On a record-breaking Match Day last month, Karen Mitchell, M.D., the director of the AAFP’s Medical Education Division, reiterated the importance of the growth of family medicine as a way to meet the needs of U.S. patients, especially in rural and underserved communities, and raising awareness about health disparities.

Our institution has maintained a family medicine match rate between 14% and 16% for the last three years. After our advising team celebrated a successful Match this year, we turned our attention to another concern. This coming year, we have the lowest number of students completing family medicine acting internships that we have had in four years. We have heard similar concerns from other undergraduate medical education leaders around the country. This has not been evaluated yet; however, our concern is that these numbers may be due to many factors.

During the pandemic, students were removed from primary care rotations. When students moved back into the clinical world, their family medicine rotations were often shared with other learners due to loss of sites. This led to fewer individual, personalized training opportunities for the students. At our institution, clerkships were shortened. The experiences were, unfortunately, different as some sites had limited faculty and an increased number of virtual visits. Additionally, the scope of student experience was limited, given that students could not care for patients if they had a possibility of having COVID-19.

Family medicine interest group attendance has been at an all-time low, likely impacted by virtual communication fatigue. AAFP student membership at the University of Colorado was also down this past year, and we anticipate this likely reflects what is happening at other medical schools.

We had fewer interactions with students early on in their medical careers. COVID-19 limitations on what students could see regarding patient care led to many of our students not being allowed to work at our free clinic, which further decreased their exposure to family medicine and primary care. Events such as an annual career exploration evening that allows students to interact with faculty from different specialties had significantly lower participation in the virtual format. Small group courses for the first- and second-year medical students in the virtual space seemed to lose the much-needed personal connection we have with students. Without the same exposure to the field of family medicine in the clinical years of medical school, and far less exposure to family physicians throughout their early training, we may be losing potential family physicians.

Furthermore, when students have been around family physicians, they sometimes witnessed those physicians at their breaking point due to the emotional toll of the pandemic.

The importance of significant exposure to family medicine role models and practice is evident in our rural track, which emphasizes family medicine and consistently contributes at least 25% of the students from our school who choose family medicine even though the track constitutes only about 10% of each of our medical school classes.

Nationally, the number of students who matched into family medicine increased in 2021. However, the percentage of osteopathic seniors matching into family medicine continues to slowly decline at 22.8%, and U.S. allopathic seniors make up only 8.8%. Although we hope that the growth of our future workforce continues, we are concerned that the COVID-19 pandemic may have an unseen ripple effect that is on its way. As we celebrate the 2021 Match for family medicine, we need to continue to focus on how we can expose our current students to our field. If we become complacent and do not focus our efforts, we could be looking at 10% — instead of 25% — by 2030.

Melissa Johnson, M.D., is an assistant professor in the University of Colorado Department of Family Medicine.

Cleveland Piggott, M.D., M.P.H., is Vice Chair for Diversity, Equity, Inclusion and an assistant professor in the University of Colorado Department of Family Medicine. He also is faculty at the University of Colorado Family Medicine Residency

Mark Deutchman, M.D., is a professor in the University of Colorado Department of Family Medicine, director of the School of Medicine’s rural track and an associate dean for rural health.