Comparing Family Practice Sources

The nation’s MD, DO, NP, and PA graduates that remain in family practice are by far the most important solution for health access. Only family practice can be demonstrated to distribute according to the population and not according to concentrations of workforce or health spending. It is important to understand that not all sources remain in family practice in the years after graduation.

Family Practice Retention Using Different Measures

Advance for PA and NP surveys have more detailed information that goes beyond just training program. AANP data indicates training or main specialty, but is limited in actual work components. Workforce cannot be defined without important components that define the actual work - such as positions and employment – especially for the most flexible primary care training sources (NP, PA, IM) where over 65% of graduates are found outside of primary care delivery.
Family medicine remains over 90% in family practice employment throughout a career. The distortions of US health policy have driven away all sources from primary care except those most permanent - family physicians. Few other options are a good thing for health access for most Americans. In studies of 1997 – 2003 family medicine residency graduates only 2% had entered additional training by 2005. About 1 percentage point was found in either geriatrics or sports medicine and 1% entered obstetric, surgical, psychiatric, or other training including primary care training. There was no deterioration across the six graduating classes (about 2% across each class) – another indication that family practice is an enduring choice for family physicians. Family medicine residents have consistently been the marker to compare retention in career choice.
Retention within family practice insures a consistent rural level of 22% or more for all graduating classes found in rural locations (3 times other physicians), over 14% found in high poverty underserved locations (2 times other physicians), and over 50% (2 times other physicians) found in 30,000 zip codes outside of concentrations of physicians with 65% of Americans.  Family physicians are found at 30 per 100,000 across the wide range of populations and locations in need.
Nurse practitioner training can claim 50% of graduates trained family practice, but only 25% of NP workforce remains in family practice employment. Also since NP workforce is the most recently graduated workforce due to recent rapid expansions, further departures to even lower FP proportions should be expected with additional years after graduation. Unlike family physicians that are relatively fixed in family practice, nurse practitioners have many other opportunities and locations and specialty choices at greater rates of pay. These also generate more revenue for employers than primary care. These strong forces work year after year to divert nurse practitioners away from primary care, rural, and underserved locations – even when they train in family practice.
Physician assistants have followed the physician design shaped by the health policy construct. This has resulted in declines from over 40% to less than 20% entering family practice in the past 25 years. The newest PA graduates should follow the pattern of the last few decades by continuing to depart primary care and family practice in the years after graduation. This was noted across the primary care friendly 1990s by Larson and Hart.
Physician assistants dedicated to family practice have what may be the top rural proportion at 30%. Other PA types that are all below the 15% in rural practice PA average. Family practice PAs are 30 times more likely to be found in a federally qualified rural health clinic, 6 times more likely to be found in Community Health Centers, and 2 – 4 times more likely to be found where needed when compared to other PA types (AAPA). Departure from family practice moves physician assistants away from all locations and populations in need of health access.
The secret of health access is retention in family practice. When comparing SMART solutions, those dedicated specifically to family practice activities and duties day in and day out are most important. Most retention, most active in practice, most volume, and most years helps make the most for SMART Basic Health Access


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