Characteristics of Family Medicine Residency Graduates, 1994-2017: An Update

Discussion

With an estimated shortage of primary care physicians and rapid growth of hospitalists,^1,9 we found that FM residency training both supplies and retains physicians in the primary care workforce, a prerequisite for the Triple Aim: better patient experience, better population health, and lower costs.¹⁰ From 1994 to 2017, 91.9% of all graduates of FM residencies (and 98% of those whose last training was in FM) self-designated FM as their primary specialty—a 2.5% improvement on physician retention compared to 1969-1993.⁶ The number of fellowship opportunities that can lead to FM board certification is limited compared to other primary care specialties such as internal medicine,¹¹ which could contribute to the high percentage of FPs who designated FM as their primary specialty. If residency graduates continue to practice FM at a 90% level, AAFP’s 25×2030 initiative could lead to a future output of 22.5% of medical students providing primary care.^12,13

This report continues efforts to measure outputs of FM residency training. On average, FM residencies graduated 2,782 residents each year 1994-2017, nearly 400 more than the annual average during 1969-1993.⁶ The peak supply of FM residency graduates during 1998-2001 corresponded to the brief surge in the number of primary care physicians after mid-1990s when health maintenance organizations promoted primary care physicians as gatekeepers in their care delivery model.¹⁴ Compared to 1969-1993, self-designated primary specialties of FM graduates were comparable except that FM/sports medicine has replaced emergency medicine as the second most-designated specialty. Substantial increases in DOs, IMGs, and female graduates in our study, concurring with greater racial and ethnic diversity in FM residents documented elsewhere, shows a diversifying FP workforce.^15,16

Limitations

This study has several limitations. First, self-designated specialty may not represent major clinical activity. For example, FPs may not designate as urgent care yet still practice in that setting. In particular, this potential classification error may have led to a considerable undercount of FPs who work as hospitalists but have not changed their designation. We found <1% of the physicians self-designated hospitalist (0.12% as primary specialty and 0.16% as secondary specialty), much lower than 9% found in a study of 2013 FM residency graduates.⁴ Lastly, we weren’t able to distinguish between combined and sequential training, eg, residents in the psychiatry/FM and internal medicine/FM programs could have completed their training in both specialties concurrently or sequentially. This could lead to misclassification of graduates whose last training was in FM.

Conclusion

The study provides an updated national assessment of the characteristics of FM residency graduates. DOs, IMGs, and female FM residency graduates increased from 1994 to 2017, and 91.9% of all FM graduates self-designated FM as their primary specialty. These findings demonstrate that FM residency programs not only train but supply family physicians who are likely to remain in the primary care workforce.