25 X 2030: ANTICIPATING THE IMPACT

In 2025, 565 million visits to primary care physicians are projected in the United States. To meet this increasing demand, a study published in 2012 found that an additional 52,000 primary care physicians need to be added to the workforce.¹ In 2018, 3,654 family medicine residency training positions were available in 653 ACGME-accredited programs. This represents approximately 12.6% of US allopathic and osteopathic medical school graduates matriculating into a family medicine residency program.

In August 2018, the AAFP hosted a meeting to kick off a long-term initiative known as the America Needs More Family Doctors: 25 x 2030. The energy at this meeting was electric! Leaders in academic family medicine organizations came together to work towards the goal of having 25% of US allopathic and osteopathic medical school seniors choose family medicine as their career path. When viewed through the lens of 2018, this goal is daunting as it challenges our profession to double the number of students choosing family medicine as their specialty.

There are multiple opportunities for family physicians—locally and nationally, in clinical and academic roles—to support this significant effort. In academic family medicine, encouraging greater involvement from our specialty on medical school admissions committees is essential. While some schools have a mandate to increase the percentage of the graduates choosing primary care, many do not. Admissions committees must focus on criteria that predict a greater likelihood that a student will select family medicine as their specialty: women, nontraditional students, students from rural backgrounds, first generation college graduates.² In admission interviews, most medical school candidates express the very same aspirations and goals that led us to choose family medicine.

Through the pre-clerkship years, students encounter different perspectives and can be attracted by subspecialties they may not have previously considered. During undergraduate medical education, the Family Medicine Interest Group (FMIG) is critical in cultivating the interest of students through procedural workshops, advocacy, and community activities which showcase the dynamic depth and diversity of our specialty. Also critical is the influence of family physician mentors and role models on students’ perspectives. If a third- or fourth-year medical student rotates with a family medicine preceptor who constantly complains about their EHR, their harried schedule, poor reimbursements, and insurance woes, students smartly gravitate to other specialties which appear to deliver a better postgraduate life. Clinical clerkship faculty play a crucial role in portraying the family medicine clinic as a challenging, compassionate, community-oriented, and energizing practice choice.

Community family physicians have a part in the 25 X 2030 goal as well. Family physicians are well positioned to develop local pipelines to facilitate successful admission to medical school. We can identify patients within our own practices who would thrive as a primary care physician and encourage them to make use of those pipelines. Local and state family medicine organizations can collaborate to offer scholarships to promote financial equity for those students who have a high likelihood of choosing family medicine yet may have a low economic probability of matriculating into medical school.

As ambitious as the 25 x 2030 goal is, those of us involved with graduate medical education see an equally daunting challenge to have accredited, quality residency training positions ready for this influx of graduates choosing our specialty. Some would suggest this goal would require over 700 new family medicine residency programs across the country. Developing new programs and adding GME positions will require ingenuity, patience, and advocacy for sustainable financial models. In an uncertain political climate, health care must be a moral common ground on which all can stand. While increasing the number of medical students choosing to be family physicians is laudable, if these newly minted physicians don’t have residency programs to complete their clinical training we will not have achieved our goal of ensuring low-cost, high-quality health care to all Americans.

• © 2019 Annals of Family Medicine, Inc.