With an aging population and an increasing prevalence of chronic disease, now more than ever the United States is in dire need of family physicians. A study released this week on the U.S. physician workforce calls for a significant increase in the number of family physicians to meet the escalating health care needs of the American people. The study was conducted by consultants from the University of Utah School of Medicine and the Utah Medical Education Council.
The report, titled "Family Physician Workforce Reform: Recommendations of the American Academy of Family Physicians" has been approved by the American Academy of Family Physicians' (AAFP) Congress of Delegates, the organization's governing body, as the AAFP's official workforce policy.
The new AAFP policy confirms data showing the United States does not have an adequate number of primary care physicians to care for all Americans. However, the study goes further to claim the nation is experiencing a dire shortage of family physicians specifically. The report asserts that unless the U.S. health care system changes soon, the shortage will become even more severe within the next 10 years as the American population continues to age and the need for health care increases.
"We've known for a long time the nation needs more primary care physicians," said Rick Kellerman, M.D., president of the AAFP. "And our new workforce policy makes the case that family physicians are the specialists that can close the current gaps in our country's health care system."
The report explains that to meet the nation's anticipated need for primary care in the year 2020, the United States must have at least 139,531 family physicians, or a ratio of 41.6 family physicians per 100,000 people. (In 2004, there were 31.2 family physicians per 100,000 people.) To achieve that target, 3,725 family physicians will need to be produced annually by Accreditation Council for Graduate Medical Education (ACGME)-accredited family medicine residencies, and 714 annually by American Osteopathic Association (AOA)-accredited family medicine residencies. The typical ACGME-accredited family medicine residency will need to expand from an average of 21 residents to 24 residents. Overall, the new AAFP workforce policy calls for an approximate 39 percent increase in the number of family physicians to meet the health care needs of the American people.
The new study, unlike previous physician workforce studies, takes into account socioeconomic factors such as population growth, increased use of health information technology and increasing health risk factors of the country's aging population. The "Family Physician Workforce Reform" study is congruent with the recent American Association of Medical Colleges (AAMC) report, which calls for a 30 percent increase in the production of U.S. physicians. However, the AAFP's new policy specifically indicates what type of physicians the nation needs now and will need in the future.
The study also considered modern trends that significantly affect the number of physicians available to care for patients, including the fact that the number of internal medicine physicians practicing as generalists is decreasing. There also is a trend toward an increasing proportion of non-physician providers, such as physician's assistants and nurse practitioners limiting their practice to subspecialty areas.
"We know that a health care system based on primary care leads to better overall quality of care for patients, as well as more affordable health care services," said Perry Pugno, M.D., M.P.H., C.P.E., director of the AAFP's medical education division. "Because family physicians are trained to care for patients of all ages and conditions and in all environments, they are best equipped to meet the wide-range of health care needs in our country. Until the health care system places a greater value on family medicine and other primary care specialties, millions of Americans will struggle to obtain high-quality, affordable care."
In response to the study's findings, the AAFP has identified a number of goals it plans to pursue to help reform the family physician workforce, including:
- Encourage its 94,000 members to implement the TransforMED Model of Care, which includes the use of electronic health records, redesigned office space, open-access scheduling and overall care that centers on the patient;
- Support efforts to ensure health care access for all Americans;
- Actively lobby and advocate for increased payments to family physicians, which will attract medical students to the specialty and retain current family physicians;
- Work with health insurance companies, as well as with the government, to encourage them to contribute to the costs of medical education;
- Work with medical schools to attract the students who are most likely to select career paths and practice locations that will improve the current maldistribution of physicians;
- Work with residency programs to better prepare family physicians to care for the evolving U.S. patient population -- greater training on care of older adults, health disparities and the management of complex patients with chronic illnesses;
- Help establish a public-private entity to allocate funding for graduate medical education; and
- Advocate for preferential funding to residency programs that support diversity and produce those physicians most likely to practice in underserved communities in rural or inner-city areas.
The American Academy of Family Physicians last approved a workforce policy in September 1998. The 1998 policy offered recommendations based on a scenario of 50 percent family physicians among all physician generalists. That study concluded that accredited U.S. residency programs needed to produce 3,682 to 4,082 family physicians annually.
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