Family Practice Advance Access originally published online on December 22, 2005
Family Practice 2006 23(1):8-9; doi:10.1093/fampra/cmi108
Editorial |
Future of family medicine workforce in the United States
Administrative and Practice Office, OSU Family Practice at University Hospitals East, 1492 E Broad Street, Suite 1302, Columbus, OH 43205, USA; Email: Leon.McDougle{at}osumc.edu
Received 1 September 2005; Accepted 19 December 2005.
McDougle L, Gabel LL and Stone L. Future of family medicine workforce in the United States. Family Practice 2006; 23: 8–9.
Abstract
In response to the Future of Family Medicine Leadership Committee's recommendations1 The Ohio State University Department of Family Medicine convened 10 faculty development sessions covering the following strategic objectives: (1) Promoting a Sufficient Family Medicine Workforce, (2) the Role of Family Medicine in Academic Health Centers, (3)The New Model of Family Medicine, (4) Electronic Medical Records, (5) Family Medicine Education, (6) Lifelong Learning, (7) Enhancing the Science of Medicine, (8) Quality of Care, (9) Communications, and (10) Leadership and Advocacy. The focus of this editorial is on initiatives and programs to promote a sufficient family medicine workforce. In comparison to other industrialized countries, the United States ranked lowest in primary care functions and lowest in health care outcomes, but highest in health care expenditures. Despite this fact, the trend for United States medical school graduates to select subspecialty careers continues upward. Through collaboration and advocacy, we can all ensure a continued enthusiasm for the selection and retention of family medicine as a career.
Background
In comparison to other industrialized countries, the United States ranked lowest in primary care functions and lowest in health care outcomes, but highest in health care expenditures.2–5 Despite this fact, the Physician Workforce Policy Guidelines for the United States for 2000–2020, endorsed by the Council on Graduate Medical Education, concluded that the distribution between generalists and non-generalists should reflect ongoing assessments of demand.2 In addition, the Association of American Medical Colleges believes that the nation is best served by allowing individual graduates to determine for themselves which area of medicine they wish to pursue; therefore, vacating its prior position of supporting a primary care foundation of the physician workforce'.3 These recommendations were based in part on population and workforce projections.
The Council on Graduate Medical Education and Association of American Medical Colleges recommends that the number of physicians entering residency training each year be increased from about 24 000 in 2002 to 27 000 in 2015 to avoid a significant shortage of physicians over the next 10–15 years.6,7 If the actual shortage was not as significant as predicted then the modest increase of about 3000 new U.S. medical school graduates per year by 2015 would permit the U.S. to decrease its current reliance on about 5200 international medical graduates who enter residency training programs annually.6,7
In 2004, 16 648 medical students matriculated to the 125 U.S. allopathic medical schools and 50% of those schools were considering increasing their class sizes.8,9 Twenty osteopathic schools plan to admit 3280 medical students in 2005 compared with 3079 in 2002.10,11
Important demographic changes include a projected 51% increase in the number of people 
65 years of age by 2020 according to U.S. Census Bureau.12 In addition, the aging of America is expected to impact utilization of health services including increased office-based visits (Tables 1 and 2)13 and increased requirements for invasive hospital procedures.13,14 Furthermore, the U.S. population is becoming increasingly diverse by 2030 minority Americans are expected to comprise 42.5% of the projected population of 363 584 000.15
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The Institute of Medicine, through the Committee on the Future of Primary Care, has stated that primary care is not a discipline or specialty but a function as the essential foundation of a successful, sustainable health care sytem.16 Primary care physicians currently make up <40% of the total physicians in the U.S. and family physicians represent 40% of primary care physicians.17 Family physicians are most likely to practice as generalists and in rural and underserved populations.18–20
As a means to contribute to a sufficient family medicine workforce the Ohio State Department of Family Medicine has focused on three areas: (1) winning respect in academic circles, (2) making family medicine an attractive career choice for medical students, and (3) leading in implementation of science and technology in practice. Visibility of family physicians in the medical school environment has also been a priority. From Patient-Centered Medicine to Physician Diagnosis and Preceptorship experiences, the Family Medicine faculty is on the front lines in innovations in education and in teaching toward the future of medicine.
The Ohio State Medical Center is currently pilot testing an electronic medical record system that will be used throughout the medical center including all physician practice sites. In addition, a web-based system allows viewing of radiological tests. Furthermore, the Ohio State Department of Family Medicine implemented teleconferencing capability to facilitate communication between the offsite residency tracks. And the Ohio State family medicine faculty serves as principal investigators of two telemedicine demonstration projects.
Departments of Family Medicine should take advantage of opportunities to positively influence the development of a sufficient workforce to support the primary care foundation of the United States. Through collaboration and advocacy initiatives, we can all ensure a continued enthusiasm for the selection and retention of family medicine as a career.
Disclosure
This manuscript is exempted from IRB review because of less than minimal risk. No external funding was used to create this editorial. There are no conflicts of interest associated with this manuscript.
References
1 Martin JC, Avant RF, Bowman MA et al. The Future of Family Medicine: a collaborative project of the family medicine community. Ann Fam Med 2004; 2(Suppl. 1): S3–S32.
2 Starfield B. Primary Care: Concept, Evaluation, and Policy. New York: Oxford University Press; 1992; 6: 213–235.
3 Starfield B. Primary care and health. A cross-national comparison. JAMA 1991; 226: 2268–2271.
4 Starfield B, Shi L. Policy relevant determinants of health: an international perspective. Health Policy 2002; 60: 201–218.[CrossRef][Web of Science][Medline]
5 Starfield B. Is primary care essential? Lancet 1994; 344: 1129–1133.[CrossRef][Web of Science][Medline]
6 The Council on Graduate Medical Education. Physician Workforce Policy Guidelines for the United States, 2000–2020. Sixteenth Report January 2005. pp. 1–78. Available at: http://www.cogme.gov/report16.htm (accessed 6 July 2005).
7 AAMC. The Physician Workforce: Position Statement. 22 February 2005. Available at: http://www.aamc.org/workforce/12704workforce.pdf (accessed 6 July 2005).
8 AAMC: Data Warehouse: Applicant Matriculant File as of 16 November 2004. Available at: http://www.aamc.org/data/facts/2004/2004school-2.htm (accessed 6 July 2005).
9 Salsberg E. The Physician Workforce Research Agenda, Expanding the Science, Enhancing the Impact. 2005 AAMC Physician Workforce Research Conference. Washington, DC, 5 May 2005. Available at: http://www.aamc.org/workforce/12704workforce.pdf (accessed 6 July 2005).
10 AACOM. Enrollment Data Entering Class of 2005. Available at: http://www.aacom.org/colleges/enrollment.asp (accessed 6 July 2005).
11 Sweet S. Undergraduate osteopathic medical education. J Am Osteopath Assoc 2004; 104: 460–467.
12 Hobbs FB, Damon BL. 65+ on the United States. U.S. Census Bureau: 23–190. Available at: http://www.census.gov/prod/1/pop/p23-190/p23190-f.pdf (accessed 76 July 2005).
13 CDC. National Center for Health Statistics (NCHS). Visits to office-based physicians: distribution by physician specialty, age, sex, and race. United States, selected years, 1975–2002. Available at: http://209.217.72.34/aging/TableViewer/tableView.aspx?ReportId=474 (accessed 6 July 2005).
14 CDC. National Hospital Discharge Survey. Available at: http://www.cdc.gov/nchs/about/major/hdasd/nhds.htm (accessed 6 July 2005).
15 U.S. Census Bureau. U.S. Interim Projections by age, sex, race, and hispanic origin. Available at: http://www.census.gov/ipc/www/usinterimproj/ (accessed 6 July 2005).
16 Institute of medicine. Primary care: America's health in a new era. Washington, DC: National Academies Press, 1996; 27–51.
17 American Academy of Family Physicians. Family physician workforce reform: recommendations of the American academy of family physicians. AAFP reprint no. 305. Leawood, Kansas, 1998.
18 Burnett WH, Mark DH, Midtling JE, Zellner BB. Primary care physicians in underserved areas: family physicians dominate. West J Med 1995; 163: 532–536.[Medline]
19 Fryer GE, Green LA, Dovey SM et al. The United States relies on family physicians, unlike any other specialty. AAFP 2001; 63: 1669.
20 Kahn NB, Schmittling G, Ostergaard D, Graham R. Specialty practice of family practice residency graduates, 1969 through 1983. A national study. JAMA 1996; 275: 713–715.
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