Meeting society’s need for family physicians – editorial
Daniel J. Ostergaard
Meeting Society’s Need for Family Physicians The public continues to express its desire for family physicians and the services that they provide, but for the second year in a row, information from the National Resident Matching Program (NRMP) indicates a downward trend in the number of medical students selecting careers in family practice. The national rate of filled first-year positions in family practice residencies in March 1987 was 83 percent. That fill rate fell to 73 percent in 1988 and dropped again to 71 percent in March 1989. Although the percentage of first-year positions filled increases substantially between March and the beginning of the academic year on July 1, the trend is still disappointing and must be analyzed further.
Family practice is not alone among the so-called primary care specialties in experiencing this decline. The fill rates for internal medicine and pediatrics also decreased again this March, and the downward trend has been apparent in those specialties longer than it has in family practice.
The decline in student interest in family practice as demonstrated by the NRMP statistics does not point to a full-blown crisis. In fact, we can take a measure of peace from the observation that the decline from 1988 to 1989 was far smaller than the decline in the previous 12-month period. And the decline in total residents matched into first-year positions dropped from 1,768 to 1,746 for a net loss of only 22. In addition, the number of positions available across all specialties, including family practice, increased and the number of applicants across all specialties decreased. The concern is that family practice suffered a significant decrease between 1987 and 1988 but did not rebound between 1988 and 1989, despite substantial efforts on the part of the AAFP to increase student interest in the specialty.
AAFP President Dr. James Jones, as well as the other officers and staff of the Academy, have worked diligently in the past year to increase student interest in family practice. This increased emphasis on recruitment of students into the specialty will continue in the coming years.
In the meantime, the broader issues facing medicine and the specialty of family practice must be reexamined in the context of declining student interest.(1,2) If society is to be served in the future by highly competent, well-trained physicians who provide access to the health care system and continuing comprehensive care throughout the range of medical needs, the following issues must be addressed(3):
1. Reimbursement inequities that currently dissuade students from entering family practice and other primary care specialties must be corrected.
2. Visibility and status of family practice, other primary care specialties and the medical schools of the United States must be enhanced.
3. Accurate and realistic information about the future of family practice, primary care specialties in general, and all of medicine must be made available to medical students throughout the years of medical school.
4. Family physicians must serve as positive role models and not intentionally dissuade students from entering careers in medicine and, specifically, in family practice.
The patients whom we serve desire the type of care that family physicians provide. Let us look at the current decline in medical student interest in family practice as a challenge not only to encourage students to enter our specialty but to address these larger issues with legislators, educators and our colleagues. REFERENCES (1)Council on Long Range Planning and Development. The future of family practice: implications of the changing environment of medicine. JAMA 1988;260:1272-9. (2)Siwek J. The future of family practice [Editorial]. Am Fam Physician 1989;39(2):85-6. (3)Siwek J. Turning students on to family practice [Editorial]. Am Fam Physician 1988;38(3):90-4.
COPYRIGHT 1989 American Academy of Family Physicians
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