We Are Not Growing Primary Care, We Are Shrinking It
AAFP has had its usual promotions of successes in the match as there are incremental increases in the number choosing family medicine. There is nothing to cheer about. FM graduates have had an annual growth rate barely keeping up with the annual population growth rate since 1980 when 3000 graduates were first reached. Given that only half of the 2018 graduates will serve careers in primary care, the actual primary care contributions have decreased much faster.
|Appearance of Primary Care (Grads)||Total Grads||Retention Believed||Activity Assumed||Volume Assumed|
|Realistic Class Yr Contribution||Grads||Retention in Primary Care||Activity in Practice||Volume Adjustor|
|SPC Years||Years in Career|
- Lower Activity
- Lower Primary Care Retention as in past decades
- Fewer Years in a Career
- Lower volume as productivity has declined
- Internal medicine graduates have declined in primary care from 16 to 1.6 Standard Primary Care Yrs
- Pediatric grads from 21 to 6.6
- FM grads from 25 to 7 - best source (dubious honor given low contributions for all) due to highest activity, retention, volume, and years - but fading
- NP from 3.2 to 2.7 - NP has never been a good source due to lowest activity, volume, and years in a career
- PA from 7.7 to 3.7 - PA is also not a good source due to lower retention, lower volume
The PA data indicates a decline from 54% family practice to less than 25% from the 1980s to the present. Studies confirm essentially no added primary care despite a doubling of PA annual graduates. The same is seen in DO expansions.
- FM 16% rural for newest graduates for 4.0 Rural Standard Primary Care Years. FM once had 7.6 Rural Standard Primary Care years per graduate for the 1970s graduates with 30% rural distribution.
- PD 8% rural for 1.7 PD 2.5 Rural Standard Primary Care Years per 1970s graduate for 12% rural (likely overestimate)
- PA 18% rural for 1.4 PA previously contributed 2.3 - boosted by the regulatory restrictions of the time forcing primary care and rural
- IM 8% rural for 1.3 IM 1.9 Rural Standard Primary Care Years per 1970s graduate for 12% rural (likely overestimate)
- NP 20% rural (likely overestimate) for 0.9 Rural SPCYrs NP 1.4 - boosted by the regulatory restrictions of the time forcing primary care and also rural at 30%
- IMG IM with with 0.4 Rural SPCYrs given reductions for losses overseas without US Practice and lower retention. Perhaps the studies were biased by those who had a vested interest in filling US internal medicine residency programs that had difficulty filling with residents.