Recently, through the Family Medicine for America’s Health (FMAHealth) Workforce team, 8 family medicine organizations endorsed a “shared aim” to: increase the percentage of US senior allopathic and osteopathic medical students choosing family medicine from 12% to 25% by 2030. Twenty-five percent is a stretch goal aligning current efforts and resources with the ultimate primary care workforce goal of 40%.
The Four Pillars for Primary Care Physician Workforce Reform provides a blueprint with leverage points.1 ADFM expanded on this to illustrate points where Departments of Family Medicine (DFMs) could engage along the “four pillars” continuum,2 and the ADFM Education Transformation Committee provided a worksheet further addressing where DFMs could engage locally.3
In the last 3 years, the FMAHealth Workforce Team has explored strategies along the “four pillars” continuum. The FMAHealth Workforce Team’s analysis of engagement is summarized below:
Pipeline
Workforce Diversity
Improving health professional diversity is central to pipeline efforts to produce the diverse primary care workforce needed. Collaborative efforts outside family medicine, such as the “Beyond Flexner Alliance,” and working with leadership from organizations with missions including improving the health of underserved communities, are essential.
Student Factor Analysis
Medical students’ specialty choice is a multifactorial process. Virtual focus groups conducted with both M4 students who choose and do not choose family medicine at schools with high and low family physician production identified several key themes, including a need for high quality preceptors, the value of rural family medicine experiences, understanding the full scope of family medicine, and the importance of “top down” institutional influences.
Impact of Organizational Programming
Through work with the AAFP, preliminary data analysis on family medicine Interest Groups (FMIGs) identified significant positive correlates to match rates. Data showed that FMIG support is an important strategy for maintaining and increasing student choice, but should not be the only strategy, as students are motivated by different experiences and values. Attending the AAFP National Conference and AAFP student membership may also play an important role.
Process of Medical Education
Identity of “What Matters:”
To identify changes in medical education with the greatest potential influence on student choice, the ADFM surveyed Department Chairs, medical school models of positive deviance were investigated, and focus groups of key stakeholders were conducted. A partnership between FMA-Health, AAFP, STFM, and ADFM created a Family Medicine Student Choice Learning and Action Network (SCLAN) to learn, test and measure the impact of interventions. ADFM’s work on the Best Practice Guidebook Project will provide a SLAN pilot tool.
Training Future Advocates
As family physicians, one of our most important roles is as advocates for our patients. A CERA Program Director survey and national student/resident survey will identify needs and contribute to a model curricular resource for advocacy training.
Leadership Development
Through the Primary Care Leadership Collaborative (PCLC), a collaboration between FMAHealth, AAFP, and Primary Care Progress, a new FMIG leadership model is being tested teaching relational leadership skills. PCLC trains medical students to take meaningful action that advances their local primary care communities.
Shortage of High Quality Primary Care Community Preceptors
Identified by FMAHealth as an important issue, STFM convened a multi-stakeholder preceptor summit which included students, residents, health system leaders, policy experts, clerkship directors, community preceptors, and non-precepting physicians. The subsequent action plan identifies partnerships and initiatives to drive health system change.
Practice Transformation
Burnout prevention and wellness are major focus areas for physicians and trainees. Student and resident leaders implemented awareness-building strategies and assessed what has the biggest potential for change.
Payment Reform
Faculty Salary Gap
In addition to the broad impact which payment reform has on primary care physician workforce development,2 the payment gap between faculty and employed/private practice physicians should be a part of payment reform work.
These programs highlight the collective impact of family medicine organizations on increasing student choice. Looking deeper into the evidence, collaborative opportunities within and outside family medicine, and innovative work around the four pillars will allow each of us to contribute to the shared aim.
Footnotes
For this issue, the ADFM is pleased to use this space for a paper by Family Medicine for America’s Health, a collaboration of ADFM and 7 other national family medicine organizations. We also acknowledge specifically the contributions of ADFM’s Education Transformation Committee.
- © 2018 Annals of Family Medicine, Inc.