HealthMarch 17, 2020

Do more primary care residencies mean more primary care providers?

By: Brian Wu, MD, PhD

If you follow Match Day each year, you probably know that Match Day 2019 — the largest ever — saw significantly more primary care residencies filled than the year before. With a country in greater need of primary care providers than ever, many hailed this as a step in the right direction.

However, this doesn't mean the problem is solved. If you're considering a residency in primary care, it's worth noting that many organizations, including the American Association of Family Physicians (AAFP), still believe that more fundamental shifts in American healthcare are needed to attract more students to general practice.

An upward trend in primary care residencies

According to the American Medical Association (AMA), the overall 2019 Main Residency Match® set a record for the number of applicants (38,376). The number of first-year positions available increased by more than 6% from 2018, topping out at 32,194. Some of this rise is because of the growing number of osteopathic graduates joining the Main Residency Match as part of a shift to a single accreditation system for graduate medical education. Many of the programs that joined the Match for the first time in 2019 had been accredited in the past by the American Osteopathic Association and are now accredited by the Accreditation Council for Graduate Medical Association.

When it comes to family medicine and primary care residencies specifically, the American Association of Family Physicians (AAFP) noted that 2019 marked a full decade of growth for the specialty and the seventh consecutive year that the number of students matching into family medicine has set a record. The numbers themselves are promising: 3,848 medical school seniors matched into residency programs in family medicine, an increase of 313 residents from 2018's numbers.

However, not all specialties in primary care fared as well. According to MDEdge, for example, pediatrics added 79 positions for 2019 for a total of 2,847 matches. This represented only a modest increase of less than 3% over the previous year's Match.

Unpacking the numbers

What do these numbers mean for you? Given the shortage of primary care physicians (PCPs) in the United States, the increase in primary care residencies is welcome news. According to Family Medicine, the country could face a shortage of more than 33,000 primary care physicians by 2035. There are various demographic and social factors contributing to this issue, including population growth, particularly in the elderly, and the retirement of currently practicing physicians.

It's a problem that needs solving because, as the AAFP notes, research has shown that areas with higher rates of PCPs have been associated with lower mortality rates from cancer, heart disease and stroke as well as lower infant mortality rates and higher birth weights. Other positive outcomes for areas with higher rates of PCPs include decreases in emergency room visits and hospitalizations, along with immunizations rates at or above the national average.

The complexity of this issue means that the increase in primary care residencies on Match Day 2019 doesn't reverse troublesome trends in primary healthcare. MDEdge also pointed out that while positions that were offered in family residency programs did increase in 2019, only 39% were filled by US allopathic seniors and that this actually represents a decrease in the number of allopathic seniors who are matching. The biggest increase was actually seen in osteopathic doctors, with 986 DOs matching in family medicine (26% of overall matches).

Dr. Clif Knight, the AAFP's senior vice president for education, suggested that this dip in senior numbers should be seen as a warning sign. In many medical schools, according to Dr. Knight, "students face an academic culture and curriculum that de-emphasize primary care and especially family medicine."

When addressing these problems, the medical community must focus on medical school culture and how it influences students' specialty decisions. This culture could be one of the biggest reasons students decide not to enter family medicine. Family Medicine identified the following three factors as among the most crucial in influencing students' decisions:

  • Perspective: The way family medicine is viewed by a student's medical school faculty, mentors and peers
  • Choice: Barriers or encouragement offered by medical training
  • Exposure: Students' experiences with the subject, including time spent during family medicine rotations

"Medical students sense that lack of value and can see, in policy and payment strategies at state and local levels, the hesitancy to fully invest in primary care," Dr. Knight said. "For far too many students, these intuitive insights and unfortunate realities lead them to make alternative specialty choices."

Brian Wu, MD, PhD
Lippincott Medicine
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