Criteria for Excellence | Chapter 1: Workforce and mission

A Program of Excellence will produce family medicine graduates who will fulfill the primary care workforce needs of the communities that it serves. The review article, Results of the 2017 National Resident Matching Program^® and the American Osteopathic Association Intern/Resident Registration Program​ by Kozakowski, et al, clearly demonstrates that the current family medicine residency annual output across the nation is falling significantly short of societal need. The percentage of family medicine residency graduates compared to total annual residency graduates is falling.

Given this situation, it is incumbent on a Program of Excellence to continually assess and update their residency capacity plan and determine whether resources (budget, faculty, capital, plant, applicant pool, etc.) could support program expansion. Programs of Excellence will try to maximize capacity to match their resource constraints. The changing health care and political climate can threaten even long-standing residency programs that have been in favor by stakeholders. Programs should always be prepared to demonstrate their direct, indirect, and intangible benefits.​

A Program of Excellence can utilize models such as community-oriented primary care (COPC)​ to assess the health needs of the community and the population that it serves. This model has three major process steps:

• Define the community of interest
• Identify the health problems of the community
• Develop and implement interventions to address those problems

A Program of Excellence will know the ratio of primary care to overall physician workforce for the communities they serve, as well as the composition of the local primary care workforce, including:

• Scope of services provided;
• Access to care;
• Comprehensiveness of care;
• Continuity of care; and
• Coordination of care provided to the community.

Use data to understand community needs

The Center for Disease Control (CDC) County Health Rankings and Roadmaps​ provide a tool to identify local health care outcomes and health factors, including social determinants of health that impact the health of the community members. The tool also includes the local ratio of primary care physicians to the population and allows comparison to other counties, the state, and the nation.

Geospatial health care mapping tools, such as HealthLandscape​, can be helpful to assess community health needs. Each residency program’s graduate survey​, as required by the Accreditation Council for Graduate Medical Education (ACGME) Review Committee for Family Medicine (RC-FM) and managed through a partnership with the American Board of Family Medicine, is a useful resource to understand the demographics and scope of practice of the program’s graduates. Patient and family advisory councils can also provide valuable insight to community needs.

Establish workforce goals with community stakeholders

Workforce targets should be established in conjunction with various stakeholders within the sponsoring institution and the community. The creation of buy-in by the stakeholders is critical to demonstrate that the program is delivering value. This buy-in may require negotiation because the workforce needs may not be self- evident to some stakeholders, particularly if they believe that the extant residency size and diversity mix, or the composition of the local medical specialty mix, appear adequate to provide a collection of services that have kept the supporting institution solvent in the past.

Increasingly, pipeline activities, such as pre-med school outreach and mentoring are essential in attracting needed diversity of medical school applicants to meet workforce goals, including underrepresented minorities and rurally-based students. Activities that build a pipeline that expose elementary, high school, and college students to family medicine such as The Ladder program​ may be a valuable long-term investment for the residency.

Recruit medical students to meet workforce needs

The recruitment of medical students should be examined to ensure that the processes currently in place have a high rate of success in meeting the established workforce targets. The Four Pillars for Primary Care Physician Workforce​ model, created by the Council of Academic Family Medicine (CAFM) in conjunction with the American Academy of Family Physicians (AAFP), the AAFP Foundation, and the American Board of Family Medicine (ABFM), serves as a blueprint for increasing the number of family physicians.

Program leaders should consider their present supply chain of students and consider alternative tactics, such as targeted recruitment efforts to attract underrepresented minorities to the program.

Create opportunities for students to experience your residency

Acting sub-internships and other opportunities that expose medical students to the residency program, transformed clinical practices, and excellent and inspiring role models over a prolonged time can build affinity for the student to the program, as well as provide the program a chance to see the student in action.

These limited opportunities can be expanded by using the practices of local alumni as additional elective rotation sites, especially if students can participate in some of the residency activities, such as morning report or noon conferences. Other options include support for local family medicine interest groups and working inter-professionally to engage in the training of other health professions students.

Programs of Excellence regularly assess the level of success of their workforce plan and readjust accordingly using quality improvement models such as Plan- Do-Study-Act (PDSA) or Define, Measure, Analyze, Improve and Control (DMAIC).