|
|
|
|
|
|
||||||||||||||||
|
Supreme Court Reaffirms Affirmative Action Policies Institutions Grapple with New HIAA Regulations "Operation Tipoff 2" Bioterrorism Exercise Offers Educational Lessons Family Medicine: Trying to Fill the Ranks Current & Choice: 'Prime Time Innovations in Medical Education: The Arts as a Teacher A Word from the President: Educational Diversity is a Compelling Interest Viewpoint: Loan Help for Researchers
|
|
Family Medicine: Trying to Fill the RanksBy Suria Santana Continuing a decline that began in 1997, family practice residency programs this year filled 2,239 of 2,940 positions offered on "Match Day," resulting in 115 fewer matches than in 2002. By comparison, before this six-year downward trend began, the 1997 Match produced 2,905 family practice residency slots, the highest number of matched positions in the field to date. According to the American Academy of Family Physicians (AAFP), decline in student interest in family medicine is not limited to U.S. allopathic medical school graduates. Osteopathic family practice residency programs filled just over half of their open positions in 2003; only 215 of 417 openings. The Canadian Resident Matching Services reported a fill rate comparable to U.S. Allopathic family practice residency program rates, at 79 percent. Although student interest in the different specialties has proven to be cyclical, some see this latest decline as reason for concern. AAFP President James C. Martin, M.D., FAAFP, has said that "this continuing decline in the number of future family physicians will be devastating to the health of the American people. Family doctors conduct almost 200 million office visits each year -- that's 75 million more visits than any other medical specialty. Family physicians are the backbone of the American health system." Bringing it back home
When evidence of a declining interest in family medicine surfaced in 1998, the University of Arizona commissioned a study to examine medical schools of varying sizes, comparing those that had produced significant numbers of family medicine students to those that had seen a drop in student interest in the specialty. "The results showed that who we bring in to medical school does play a role in determining [whether or not we produce] family doctors," says Dr. Martin. "If you bring in somebody from a rural, underserved area who has a family there, that person is much more likely to go back to that community, or to a similar community, and work as a family doctor than the cardiologist's son from New York City." The number of students who pursued family medicine as a specialty appears to rise in proportion to the exposure they have to the field during their medical education, Dr. Martin says. "The study showed that the schools that were turning out more family doctors had early and frequent exposures to family medicine," he says, adding that schools showing similar results "had credible role models in their family medicine departments. "What medical students are saying now is that they really like the idea and the concept of family medicine," he says. Students see family doctors as an idealistic bunch, with valuable people skills. "On the other hand, they are complaining that these physicians work too hard and don't get paid properly for what they do," he adds. Debt concernsAnother potent concern is money, and student debt. The annual median pay for family doctors in 2001 was $145, 675, according to American Medical Group Association's figures, making family medicine one of the lowest-paid specialties. Even though the average medical student's debt is close to that salary figure, Dr. Martin says concern about paying back loans does not influence a student considering family medicine. "If a student has his mind made up, debt load doesn't stop him."
One point of particular importance to medical schools is something the University of Arizona study has identified as a negative medical school culture. "In talking to the subspecialists in the academic health center, family medicine is viewed as an 'inferior' product," says Dr. Martin. "In the community, the subspecialists say that we have no healthcare system if we don't have good family doctors, while in the academic health center, they are not as valued. A lot of medical students admire family medicine and if the circumstances were different would look into it, but all those factors outweigh idealism," he adds. But J. Lloyd Michener, M.D., Chairman of the Department of Community and Family Medicine at Duke University School of Medicine, doesn't think that the environments in medical schools can strongly affect students' career choices. "We can role-model, we can support, we can have family medicine interest groups and make sure that students experience the fun, challenge, and excitement of being a practicing family physician, but we can't ultimately force people into careers in which they aren't interested." The latest trends showing a decrease in student interest in family medicine are not something to be worried about, Dr. Michener says. "It looks like students are less interested in generalism overall, and in family medicine specifically, and that's part of a longer-term cycle," he says. "Student interest tends to fluctuate over the years and we certainly have seen that happen in other specialties as well. I think we'll see the cycle reverse itself again [for family medicine]." Social concerns
Dr. Michener credits larger social issues - including those specific to the ideology of the current student generation - to family medicine's recent drop in popularity. Like Dr. Martin, he thinks that the perception that family doctors work harder than other types of physicians may be influencing students' decisions. "Nowadays, folks are much more interested in maintaining a lifestyle and having work hours that are more strictly governed," he says. "Going into a busy private practice of family medicine is less attractive today than it was before, so the specialties in which you can leave the office and leave work behind you appear to be more attractive to students." Members of the X and Y generations also might have a greater interest in professions that appear to be more "high tech," he adds. "As we start teaching students who grew up with computers and to whom technology is very commonplace, there's going to be an increasing interest in careers that have 'informatics' at their fingertips," Dr. Michener says. "There are certain careers in which that is easier to find than others, and family medicine thus far has not been one of them." AAFP studies have led to similar conclusions. As part of the organization's "Future of Family Medicine Project," a joint effort of the Family Practice Working Party and the Academic Family Medicine Organizations (supported by the AAFP), a committee of experts identified a set of challenges facing family medicine, technology implementation being one of them. "America is obsessed with science and technology," says AAFP's Dr. Martin. "When the public thinks of family medicine, they think of neither. So we have to find ways to bring technology and science into the profession." Managed care woes are also to blame for the diminished appeal of the profession, according to Dr. Martin. "People went into family medicine in large part because of the relationships they developed over time. Research shows that both the patients and the physicians think that's the key element," he says. "They all want that close, personal contact with a personal physician. Managed care has totally disrupted that." Many managed care companies refuse to pay for services that are under the scope of family medicine practice because their regulations assign other professionals to their provision. An example would be services for depression and anxiety, which many managed-care companies pay social workers to supply, says Dr. Martin. The problem of improper reimbursement for government healthcare programs, such as Medicare, is yet another factor. "If you look at the research of who takes care of our geriatric Medicare population, almost 70 percent of that care is provided by family doctors," he says.
Family doctors also provide a substantial amount of the care in what are known as primary-care health-professions shortage areas, he adds. "If you take just these two groups of providers away, you've got a catastrophe of healthcare delivery in this country. At some point, the people in the medical schools have an accountability to the public, since they are taking some taxpayer dollars." But Dr. Michener argues that influencing students' career choices should not be the responsibility of medical schools. "Is it the job of the medical schools to train people for the disciplines that are perceived as needed by the country, or is to train medical students who can make their own choices on what they want to go into?" he asks. "We never really reconciled these two perspectives … . I don't think the U.S. will ever have a system in which we tell students what specialty to go into. What we can do, however, is try to make the choices clear, try to even out the major discrepancies in payment for services rendered, then let students choose based on what they think best suits their needs, and interests." The consequences of the genomic revolution - specifically, a switch from an emphasis on disease treatment to disease prevention - will likely result in an increased demand for family physicians, Dr. Michener argues. "I think family medicine is actually going to get much more popular in the future," he says. "We are going to have much more of a need for family physicians as our ability to screen for disease gets better. With all the genetic tests that are coming out, there is going to be a huge need for primary care practices that cannot just take care of people with the diseases they already have but also screen people for the diseases they might get, and to help them avoid these conditions." |
||||||||||||||
|
||||||||||||||||
|
Contact Us © 1995-2008 AAMC Terms and Conditions Privacy Statement |
