Family Practitioners Challenged with Fewer Graduates But Are the Last Remaining Permanent Primary Care Form in the United States

Robert C. Bowman, M.D.

Only the family practice MD, DO, NP, and PA practitioners deliver top levels of primary care, rural workforce, and underserved workforce in the United States and only the family practice physicians remain in this broad generalist family practice form. Internal medicine has collapsed as a source of primary care with less than 10% of graduates (or more) expected by surveys and recent declines to remain in primary care. Pediatric graduates are likely to have 50% primary care retention at best. This means that medical schools graduating the most family physicians contribute the most primary care. United States medical school graduate choice of family medicine has plummeted. This is a result of US health policy that absolutely fails to support primary care and the lower and middle income patients most dependent upon primary care. When the US improved support of lower and middle income patients through Medicare and Medicaid and improved primary care support (Graphic), the US quadrupled primary care numbers from 1970 to 1980 and increased primary care by 50% in just a few years in the 1990s. Other than these health policy periods, the United States has been ignoring primary care with flat primary care active graduates despite increasing population over many decades. (Graphic)

Another problem is that US graduates most likely to choose family medicine are shut out of medical school admission in the United States. Many have given up while others have bypassed US schools. Family physicians are more likely to arise from lower and middle income and lower and middle population density origins. (Graphic) US medical schools have moved steadily more exclusive in admission, in training, and in career choice. The entire process leaves family medicine behind just as it leaves 65% of Americans and 70% of the elderly behind in 29,000 zip codes that depend upon family practice contributions. These are zip codes outside of concentrations that have only 20 – 25% of physicians and non-physicians but have 50 – 60% of the family practice MD, DO, NP, and PA practitioners. (PDC)

Main Graphic

Graphic MCATFMmatch07.GIF

Graphic MCATandSPCandMS98label.GIF

Schools that admit the most exclusive medical students have the most exclusive MCAT scores. The most exclusive students also have the lowest choice of family medicine. Schools that concentrate exclusive origin students also train exclusively in top concentrations of physicians, specialists, and health resources. Schools that admit the broadest range of students in income origins, population density origins, and older ages admit physicians with higher to much higher probability of family medicine choice and contribute the most primary care due to the 29 Standard Primary Care Year per family physician boost, a level 7 times the contributions of the flexible primary care forms of IM, PA, and NP with 2 – 4 Standard Primary Care Years per graduate. (Link) As an example, Ross University in the Caribbean with 115 family physicians out of 469 graduates in 2009 is the largest single source of primary care for the United States. Medical schools focused on family medicine and primary care may find it more difficult to stick to health access missions in the current policy period, but those that remain steady in admission and training emphasis will be increasingly important to basic health access.