Most Family Medicine Residents Remain in Specialty

Randy Dotinga

July 14, 2020

As many primary care practices struggle financially, a new study offers positive news about the retention of family medicine (FM) graduates in the specialty. According to the research, at least 85% of physicians who completed FM residency training in 2014-2017 went on to be certified by the American Board of Family Medicine (ABFM).

The U.S. could have a shortage of 21,100-55,200 primary care physicians by the year 2033, says a report released in June by the Association of American Medical Colleges.

Most U.S. primary care doctors specialize in FM, according to the American Academy of Family Physicians, and the number of physicians choosing this specialty declined over most of the period of the study, Mingliang Dai, PhD, lead author of the research, said in an interview. The study is in the July/August 2020 issue of Annals of Family Medicine.

Some positive news for the specialty is that 92% of 66,778 FM residency graduates from 1994-2017 self-designated FM as their primary specialty. This represents a 2.5% improvement on physician retention in the specialty compared with the period from 1969 to 1993, reported Dr. Dai and coauthor Lars E. Peterson, MD, PhD, both of the American Board of Family Medicine. Dr. Peterson also works in the department of family and community medicine at the University of Kentucky in Lexington.

"I am not surprised by the finding and hope that it means that family medicine has continued to demonstrate its importance as a specialty," Santina J. Wheat, MD, program director of Northwestern's McGaw Family Medicine residency program at Humboldt Park, Chicago, said in an interview. "We have demonstrated to our peers during the pandemic that we are valuable team members and I hope that perception will only be strengthened.

"Many of our graduates feel very strongly about being family medicine physicians. Most of graduates are practicing outpatient primary care so this does strongly align with my experience," noted Dr. Wheat, a family physician at Erie Family Health Center in Chicago who serves on the editorial advisory board of Family Practice News.

The study authors noted that 98% of those whose last training was in FM "claimed FM as their primary specialty."

The new research provides follow-up to a landmark 1996 report that found 91% of 38,659 FM residency graduates from 1969-1993 identified their specialty as FM, Dr. Dai said in an interview.

"The statistics on the primary care workforce, especially family medicine residency graduates, have not been examined for over 20 years," the study author noted.

"We think it is important to monitor whether recent graduates continue to practice what they are trained for," Dr. Dai said.

For the new report, Dr. Dai and Dr. Peterson examined records from the ABFM and American Medical Association for the years 1994-2017. They tracked 66,778 family medicine residency graduates and found that 92% identified FM as their primary specialty. The other top specialties were FM/sport medicine (2%), FM/geriatric medicine (1%), internal medicine/geriatrics (1%), and emergency medicine (1%).

The study reveals the tremendous evolution of the FM residency pipeline since the mid-1990s. The percentage of women among residency graduates grew from 40% in 1994-1997 to 54% in 2014-2017, and the percentage of international students jumped from 18% to 29% over that time period.

The 1996 report found that just 23% of FM graduate residents were women during the 1969-1993 period, and only 12% were international students.

In an interview, Heather Paladine, MD, MEd, FAAFP, residency director of the New York Presbyterian–Columbia Family Medicine Residency Program, called the study "thorough." She also made the following comments about the new research: "It's very good news that the percentage of FM grads who practice in our field is not decreasing. Once people finish an FM residency, they stay in our field."

Dr. Paladine added that "this study validates what I have seen as a residency program director. Most of our graduates go into primary care job, and even many who do fellowships continue to practice primary care as well as their area of focus."

However, she cautioned that the study doesn't address a crucial challenge.

"The key to relieving the primary care shortage will be to look earlier in the pipeline: How can we get more medical students to choose family medicine? How can we increase the number of FM residency positions and find stable funding for them? How can we support family physicians to decrease burnout and make it a more attractive field? We know our field is needed, but insurance reimbursements are focused on more subspecialty care," she noted.

As for the years since 2017, the last year analyzed in the study, Dr. Paladine said the trends seem to be continuing.

The impact of COVID-19 is still yet to be seen, but Dr. Paladine and other experts provided possibilities for the field in light of the pandemic.

"While the nation's health care system is strained by COVID-19 patients, we have not yet seen COVID-19-related policy changes in medical education that may have a direct impact on residency programs," Dr. Dai said in an interview.

Dr. Paladine said it's possible that the pandemic could actually boost interest in medicine.

"After 9/11, I saw a number of college graduates who wanted to reach out and help people and ended up switching their plans to medical school," she said. "This may happen again after COVID."

Dr. Wheat also offered a positive outlook for the specialty.

"I am not expecting COVID to decrease the percentage of FM graduates working in family medicine. If anything, I think it will encourage them to have a broader scope and work as leaders in health care to look out for the primary care needs of our communities," she said.

Neil Skolnik, MD, associate director of the family medicine residency program at Abington (Pa.) Hospital–Jefferson Health, said in an interview that the study shows that the FM pipeline "remains strong."

Dr. Skolnik, who serves on the editorial advisory board of Family Practice News, added that "it is also good to see that there has been an increasing diversity in the composition of physicians graduating from family medicine residency programs, most importantly an increase in the proportion of women, with women now accounting for over half of graduates."

However, Dr. Skolnik noted, "it is a bit surprising that less than 1% of graduates identified as practicing geriatric medicine, given the expected increasing proportion of the population that is over 80 years of age. As a specialty, perhaps we can think about ways to encourage more graduating residents to consider geriatrics as an area of interest as there is a societal need, and it can be a very gratifying area of practice."

No study funding was reported. The study authors, Dr. Paladine, Dr. Skolnik, and Dr. Wheat reported no relevant disclosures.

Katie Lennon contributed to this report.

SOURCE: Dai M and Peterson LE. Ann Fam Med. 2020 Jul. doi: 10.1370/afm.2535.

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