CLEARED FOR TAKEOFF: THE 4-YEAR FAMILY MEDICINE RESIDENCY PILOT

Moving to 4 years of training results in at least a 3% loss of workforce for each family medicine residency graduate. One more year of training adds tens of thousands in costs and decreases the career length. The same mistake is being made by nurse practitioners who are forcing 2 more years of training to decrease length of career by 8 - 10% while adding 30% to the cost of training.

Why have we not been able to learn over the past 40 years? Each increase in length of formal training by family medicine, physician assistant, and nurse practitioner leaders has resulted in greater training cost, decreased career length, and decreased distribution to populations in most need in America.

No one who understands worsening shortages of primary care would do anything to decrease primary care delivery capacity further for the next 20 years, especially for the most important source of health access for the elderly who are doubling in the next 20 years and require 2 to 3 times more primary care (Ferrer). There is not a population or location in need that does not benefit from the family medicine multiplier - so why defeat needed workforce?

Why does family medicine remain hostage to poor designs for family medicine training? A real design is a 6 year family medicine medical school. Such a move would result in more specific training and longer careers. The six year accelerated family medicine model was associated with increased distribution - including urban origin and female graduates.

Medical education has failed for 30 years to supply the workforce needed by most Americans and more of the same will continue to fail. The 30 years of failure to expand the one source most needed by most Americans is a primary measure of medical education failure. Family medicine can present an instate permanent family practice plan to state legislatures that will actually allow them to specifically address their primary care deficits. Have we forgotten the important state level efforts that helped expand FM to 3000 annual graduates in a ten year period?

Family medicine can help solve one of the major problems facing most Americans. This is why family medicine was restored and what family medicine leaders have told us for 40 years. We should be more about family practice and basic health access and we should be less about academics and institutions and associations with locations that have top workforce concentrations already.

Real solutions would be a doubling of family medicine residency graduates, an increase in primary care delivery per graduate, a move away from training in top concentration locations, and success in achieving revenue for primary care that more than covers double digit increases in the cost of delivering primary care. These are solutions needed for the next 30 years for family physicians and for 200 million Americans behind by design.

Competing interests:   Basic Health Access for Most Americans