The United States faces a shortage of 25,000 primary care physicians (PCPs) by 2025.1 This report is a guide for departments of family medicine for developing local strategies (http://www.adfm.org/Members/Webinarsresources/Workforcestrategies) to increase the PCP workforce, framed around the 4 pillars for reform: pipeline, process of medical education, practice transformation, and payment reform.2
First Steps
The first step is to define the PCP need for the region. Next, review the factors that influence student choice for family medicine from the Graham Center report3 and also captured on the ADFM Education Committee workforce strategies worksheet (link). Then for each of the 4 pillars below consider the local barriers, required resources, and potential allies/collaborators.
Pipeline
Pipeline strategic initiatives can be targeted to the premedical, medical school, and residency stages.
Premedical
Does the department have linkages with high schools or college pre-med major programs? Do pre-medical students have opportunities to create personal relationships with PCPs in clinical settings or engage in primary care research?
Medical School
Does the medical school mission value primary care and is this reflected in admissions policies? Are there family physicians on the admissions committee? Are there negative attitudes and behaviors toward primary care? Is the department engaged with students in meaningful ways?
Residency
Are there enough graduate medical education (GME) positions for family medicine in your region? Can programs expand or can new programs open in GME-naïve hospitals? Can state or local support be garnered for expanding GME?
Process of Medical Education
Strategic initiatives for influencing the process of medical education can be targeted at medical school, community preceptor, resident, and residency levels.
Medical school
Are there strategic planning goals and measurable primary care outcomes linked to social mission content? Does the Department offer relevant and transformative clerkship experiences or teach valued fundamentals of doctoring? Do experiences engage social justice issues? Are there appealing experiences in global or underserved health? Are there scholarships to help students with educational debt?
Experience with community preceptors
Are students exposed to outstanding community preceptors? Do students develop beneficial mentoring relationships?
Experience with family medicine residents
What impressions do the residents create for students and what messages do they communicate? Are the residents satisfied and prepared for practice?
Residency
How strong is the program’s reputation? Are faculty members satisfied and enthusiastic? Does the residency clinic demonstrate features of the patient centered medical home, team-based care and the principles of primary care? Are there attractive enrichment offerings?
Practice Transformation
With primary care delivery undergoing significant transformation, what does the student experience in the community primary care office? How well implemented are patient-centered care; team-based care; role modeling of comprehensive care; use of data and addressing the social determinants to drive population health; use of technology; and achieving safe, quality outcomes? Are students witnessing physicians burning out or finding work/life balance? Do students see the value and joys of continuous physician-patient relationships?
Payment Reform
Increased salary parity between primary care and specialist physicians increases interest in primary care careers.4 Payment reform, the most important pillar5, is a critical target to be addressed at local, state, and federal levels.
Local Initiatives
Can you show evidence of family medicine’s value to the health system? Is there opportunity to advocate for the infrastructure necessary for a transformed model of care or for alternate funds flow? What needs to occur to adjust the compensation model and to offer loan forgiveness for PCPs?
State Initiatives
Are there opportunities for Medicaid payment reform that could translate into additional dollars for PCPs? Is there payment or credit for primary care precepting? Are there incentive payments for having a patient centered medical home? Are there state loan repayment/forgiveness programs to market?
If each department formulates its own set of local strategies to increase the number of students choosing family medicine, then collectively we can come closer to narrowing the PCP workforce gap over the next decade.
- © 2017 Annals of Family Medicine, Inc.
