Family medicine faculty recruitment crisis of the ’90s – Editorial
Norman B. Kahn, Jr.
Family medicine has successfully navigated a sea of crises in the past quarter of a century. In the 1970s, a rapid increase in the number of family practice residency programs was needed. In the late 1980s, the challenge lay in the discovery of new ways to bolster lagging student interest in the specialty of family practice. These problems are being addressed. 450 family practice residency programs are now approved by the American Council for Graduate Medical Education (ACGME) in the United States and the fill rate for family practice residency positions is exceptional, with 97.4 percent of positions filled on July 1, 1995.
Now it appears that the burning issue of the `90s is family medicine faculty recruitment. According to a study published in 1995 , 496 faculty positions remained to be filled in family practice residency programs and departments and an additional 677 positions were anticipated to be available within the next two years.
Family medicine entered and emerged from the 1980s with 380 family practice residencies. Within the past five years, however, 70 new programs have developed. In 1989, 22 medical schools were without departments of family medicine. In 1996, only 11 medical schools remain without a department of family medicine, and several are considering or actively pursuing departmental development. In 1993, the Liaison Committee on Medical Education (LCME) added the discipline of family medicine to the list of curricular experiences for all medical students. In the academic year 1994-95, only 40 schools remained to develop required third-year clerkships in family medicine.
The primary goal of U.S. family practice training is to put family physicians into practice where they are needed. However, new and expanded residencies, new departments and new clerkships all require more well-prepared faculty members. Therefore, an appropriate and balanced distribution of family physicians also requires a sufficient number of qualified teachers and role models, family physicians who will manage and lead the evolving health care delivery system, and researchers who will build the knowledge base from which that system will progress.
There has been a growing interorganizational response to the need for family medicine faculty. The Society of Teachers of Family Medicine (STFM), the Association of Departments of Family Medicine (ADFM), the Association of Family Practice Residency Directors (AFPRD), the North American Primary Care Research Group (NAPCRG) and the American Academy of Family Physicians (AAFP) meet as the Academic Family Medicine Organizations (AFMO) on a semiannual basis and track responses to this crisis.
The AAFP’s role has included several initiatives. In a cooperative venture, AAFP and STFM have collaborated on a directory of faculty development fellowships. Since 1992, the AAFP Commission on Education has offered a course at the annual scientific assembly entitled “Making the Move from Full-Time Practice to Full-Time Faculty.” The AAFP Division of Education has developed a packet of informational materials for practicing physicians who may be considering the move to academia.
Two AAFP publications – Family Practice Management and the AAFP Reporter – have published articles about the “practice-to-faculty” transition. The AAFP Foundation has also stipulated that its new Resident Repayment Program will include the applicant’s acceptance of a faculty position as one of three eligibility criteria. In the spring of 1996, the AAFP Physician Placement Service begins listing faculty positions in its database. With an efficient and timely data collection and retrieval system, this service will offer a unique and promising approach to physician faculty recruitment.
How does one make the transition from practitioner to academician@ Career transitions require considerable self-knowledge and personal exploration. Certainly, a move into teaching from private practice is a professional decision that should be given thorough consideration. The benefits of an academic position may include opportunities for research and scholarship, collegial interaction with other faculty, the development of mentoring relationships with medical students and residents, a more predictable work schedule and ongoing clinical involvement in patient care. Challenges may arise from the structured atmosphere of an academic bureaucracy, the administrative expectations of a supervisory faculty position or the time constraints inherent in a position comprised of varied (and demanding) tasks and responsibilities. The range of available faculty positions offers considerable diversity in exposure to these experiences.
As a preliminary “testing of the waters,” physicians may wish to serve as student or resident preceptors. Or, as a precursor to the leap into academe, a practicing family physician might participate in a faculty development workshop, such as those offered by STFM and the AAFP Residency Assistance Program (RAP). A faculty development fellowship might be an appropriate venue for initial preparation. Such fellowships are offered both full-time on-site and part-time off-site. (Descriptions of fellowship sites are contained in the AAFP/STFM Fellowship Directory for Family Physicians.) New faculty members often build faculty development into their job descriptions and/or employment contracts.
More than 1,000 additional family medicine faculty will be needed to facilitate the evolution of the specialty into the next century. Family medicine needs experienced, quality physicians among the ranks of its concerned and dedicated faculty. Faculty development materials, conferences and fellowships are available to facilitate the transition from residency and practice to teaching. The discipline has successfully prevailed through its previous crises. This challenge of faculty recruitment, which must be met, is now before us.
Dr. Kahn is director of the AAFP Division of Education and Ms. Barnes is manager of the AAFP Department of International Activities and Educational Research Policy.
REFERENCES[1.] Kahn NB Jr, Garner JG, Schmittling GT, Ostergaard DJ, Graham R. Results of the 1995 national resident matching program: family practice. Fam Med 1995;27:501-5. [2.] Holloway RL, Marbella AM, Townsend JM, Tudor JM, Tollison JW, Saultz JW, et al. Defining the need for faculty in family medicine: results of a national survey. Fam Med 1995;27:98-102. [3.] Liaison Committee on Medical Education. Functions and structure of a medical school: accreditation and the Liaison Committee on Medical Education: standards for accreditation of medical education programs leading to the M.D. degree. Washington, D.C.: Association of American Medical Colleges, 1993. [4.] American Academy of Family Physicians. Survey of medical school clerkships in family medicine. Kansas City, Mo.: American Academy of Family Physicians, 1995. [5.] American Academy of Family Physicians. Interest in full-time faculty position. Packet 247. Kansas City, Mo.: American Academy of Family Physicians, 1995. (To order, call Margaret Tripp at 1-800-944-0000, extension 2236.) [6.] Gillanders WR, Kahn NB Jr. Is it time to teach what you practice. Fam Pract Mgmt 1995;2:50-5. [7.] Training programs aim to produce more rural FPs. AAFP Reporter 1995;22(3):1,5. [8.] American Academy of Family Physicians and Society of Teachers of Famfly Medicine. Fellowship directory for family physicians. Kansas City, Mo.: American Academy of Family Physicians and Society of Teachers of Family Medicine, 1996. (To order, call Mary Ruhl at 1-800-944-0000 extension 4504.)
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