Payment Prevents Primary Care Result - No More Match Follies

Year after year various primary care associations get excited to find out the results of the match or residency choices of medical students. It is quite interesting to see how so little change is promoted so much. Even a small increase of a few dozen graduates is celebrated.

Such celebrations hide the tragedy shaped by primary care payment design. This is best seen in family medicine, by far the best remaining source of primary care.

Changes over time indicate the likely result of increased family medicine graduates. The increase from 2900 to 3200 seems significant at 10% growth. But over the same time period family medicine residency graduates have been choosing other career paths involving emergency care, hospitalist careers, urgent care, and other specialties. The specialty once 90% retained in primary care is down to below 70%. The impact of the actual primary care result is shown below:


Annual Graduates Increase in Graduates Active in FM Positions Over Career Actual FM Result By Class Year Decrease in Actual Primary Care Result
FM Grad 2000 2900 90% 2610
FM Grad 2017 3200 10.3% 70% 2240 -14.2%

Actual primary care result is about retention in primary care positions. Losses of primary care are steadily shaped by the financial design. Too little support results in 
  • Fewer choosing primary care training
  • Fewer entering primary care positions after primary care training
  • Fewer remaining in primary care positions over careers
Primary care associations need to focus upon the financial design to address primary care needs. Massive expansions of graduates are not capable of addressing increased primary care. There are only a limited number of supported primary care positions due to payments too low and cost of delivery too high and getting higher. 

Primary care leaders that trumpet match success are preventing financial changes that would actually increase 
  • the numbers of graduates
  • the members in primary care associations
  • primary care retention
  • primary care distribution
  • basic health access
  • improved support of team members
  • higher primary care functions
The shrinking financial design is what impairs basic health access.


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Robert C. Bowman, M.D.        Robert.Bowman@DignityHealth.org

The blogs represent the opinion of the blogger alone.
Copyright 2017 





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