Results of the 2008 National Resident Matching Program: Family medicine

Division of Medical Education, American Academy of Family Physicians, Leawood, KS 66211, USA.
Family medicine (Impact Factor: 1.17). 10/2008; 40(8):563-73.
Source: PubMed


The results of the 2008 National Resident Matching Program (NRMP) reflect a currently stable level of student interest in family medicine residency training in the United States. Compared with the 2007 Match, 91 more positions (with 65 more US seniors) were filled in family medicine residency programs through the NRMP in 2008, at the same time as 10 fewer (one fewer US senior) in primary care internal medicine, eight fewer positions were filled in pediatrics-primary care (10 fewer US seniors), and 19 fewer (27 fewer US seniors) in internal medicine-pediatrics programs. Multiple forces, including student perspectives of the demands, rewards, and prestige of the specialty, the turbulence and uncertainty of the health care environment, lifestyle issues, and the impact of faculty role models, continue to influence medical student career choices. Thirty-one more positions (20 fewer US seniors) were filled in categorical internal medicine. Thirty more positions (84 fewer US seniors) were filled in categorical pediatrics programs. The 2008 NRMP results suggest that while interest in family medicine experienced a slight increase in the number of students choosing the specialty, interest in other primary care careers continues to decline. With the needs of the nation calling for the roles and services of family physicians, family medicine still matched too few graduates through the 2008 NRMP to meet the nation's needs for primary care physicians.

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    ABSTRACT: Numerous reports highlight the problem of declining primary care capacity in the USA, especially in rural and remote areas. The reasons for declining primary care capacity are elusive. Little progress is likely without better definitions, tools, and approaches. The author proposes a standard primary care workforce year to adjust each primary care form for losses due to specialization, lower levels of practice activity, lower primary care volume, and shorter career length. The author reviewed studies to create a standard primary care year estimate representing the total primary care contribution for each of the five training forms of primary care over the career length of the graduate. The standard primary care year was the product of four factors: (1) the career length in years; (2) the percentage estimated to remain in primary care; (3) the percentage active in practice; and (4) the percentage of primary care volume compared with a family practitioner. A best determination was made regarding the value of each of the four factors for each primary care form. Because specialization rates increased substantially to decrease primary care contributions, the estimate for each form also had to be linked to each class year of graduates. Family practice is the best example of a permanent primary care training form with 29.3 standard primary care years expected over a 35 year career. Other training forms appear to be more flexible with graduates able to choose primary care or specialty care depending on policy and market forces. The 2008 pediatric residency graduates can be expected to serve 17.6 years of primary care. Internal medicine resident primary care contributions have been reduced by 50% in the past decade to 5.3 years with international medical graduate internal medicine contributions decreasing to 2.5 years. Physician assistant estimates have decreased to 6 years, while nurse practitioner estimates have declined below 3 years per graduate. Without changes in policy or training, the USA must graduate 11.7 international medical graduate internal medicine residents, or 10 nurse practitioners, or 5.5 US internal medicine residents, or 4.8 physician assistants, or 1.7 pediatric residents to equal the same primary care contributions as one family physician. With decreasing rural and underserved distribution levels in the flexible forms, the numbers of graduates needed to match the family practice rural primary care year and underserved primary care year contributions are even higher. The primary care year is a versatile tool that can help to estimate primary care contributions across different forms of primary care. Specialization takes a huge toll on primary care capacity. Progressive failure to retain primary care makes expansions of graduates an ineffective and costly intervention. Without graduating more who remain in primary care, the USA can expect consistently lower primary care levels. Primary care contributions of progressively shorter duration could explain the perceived rapid collapse of primary care, particularly when studies of primary care fail to involve the most recent months of changes.
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    The Annals of Family Medicine 01/2011; 9(1):90. DOI:10.1370/afm.1217 · 5.43 Impact Factor
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    ABSTRACT: ORIGINAL ARTICLES T he primary care specialties of family medicine, general pe-diatrics, and general inter-nal medicine are actively engaged in residency redesign, driven by the need to transform their disciplines and adequately prepare physicians to practice in a changing health care environment. 1-3 Others have suggested that transformation in particular must respond to the ef-fort to improve quality of medical care, balance educational needs of learners with the service needs of institutions, and teach physicians to be lifelong learners. 4-6 Fourth-year medical students may be fearful about ranking programs that are experiencing substantial change because the educational redesigns may be perceived as of-fering lesser educational value and/ or greater uncertainty than estab-lished residency program designs. Fears about participating in inno-vatively redesigned programs may result in a decrease in the quality and quantity of applicants or an in-crease in positions filled after the Match (during the scramble). Ap-plicants selected after the Match are more likely to leave programs early and/or to require remediation, which creates difficulties for pro-gram management. International medical graduates (IMGs) applicants selected in the Match are also more likely to leave their program early. 7 While each of the three primary care disciplines have different ini-tiatives for curriculum change and innovation, a consistent theme for change in all three has been cus-tomizing training for individual res-idents rather than standard block educational designs that do not of-fer flexibility. 8,9 Specifically, the Aca-demic Internal Medicine Education BACKGROUND AND OBJECTIVES: Family medicine is actively engaged in residency redesign, but it is unclear how curricular in-novation and restructuring of residency programs will affect their performance in the National Resident Matching Program (NRMP).
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