If you have been disappointed by the performance of family medicine in the National Resident Matching Program over the past few years, you won’t find this year’s results much more welcome. As the brief story on page 37 indicates, the one bit of good news – that more residents matched into family medicine residency programs this year than last – is outweighed by continuing decreases in the number of family medicine residency slots offered and the number of U.S. seniors going into family medicine.

The declines are hardly surprising, given recent trends ranging from the backlash against managed care to the increasing complexity and cost of practice, decreasing reimbursements, skyrocketing malpractice premiums, and on and on.

Seen against some backgrounds, though, the Match results might seem very surprising – even inexplicable. Consider that the results came out in the same month as the latest of many papers demonstrating that there is no societal justification for increasing the supply of limited specialists, while “there is considerable evidence for the benefits (on health outcomes) of an increase in supply of primary care physicians”¹ (read more about the paper on page 38).

Of course, the contradiction between recent Match results and the evident value of primary care would truly be surprising only if we lived in a rational society. Needless to say, we don’t. We live in a society shaped by money and politics, with a health care system distorted by unbridled enthusiasm for technology, bloated with wasteful expenditures and driven by uninformed consumers. While the article by Joseph Hawkins in this issue gives some hope that things are looking up (see page 56), it seems clear that primary care, especially family medicine, may offer what America needs, but it apparently doesn’t offer what America wants.

Aligning needs and desires

The communication challenges implied by this schism between need and want were acknowledged by the Future of Family Medicine (FFM) Project Leadership Committee, and they’re reflected in the FFM recommendations currently being implemented by the family of family medicine organizations.

Whether all of family medicine is equal to the communication challenge, time will tell. The message needs to get through to government, medical school faculties, payers, employers, medical students, practicing physicians both in primary care and in other specialties and, most of all, to patients – to the public at large. Compared with the challenges involved in getting electronic health record systems into all family medicine practices, completely restructuring how those practices work, and rethinking both family medicine education and continuing medical education, the communication and marketing challenge may be the hard part. It entails changing the image of primary care and family medicine in virtually every mind in the country. It will require a lot of work and a lot of money. It will require the active participation of all family physicians.

The FFM report was published a year ago this month.² Have you read it yet? Have you decided whether you buy it? Are you willing to commit to its recommendations? What do you think: Are we off to a good start yet?