The bottleneck in ensuring sufficient primary care physicians

The past few months I have joined thousands of individuals hoping to match into a residency program in 2014. I have had interviews all over the country and spent way too much time living out of a suitcase.

For many students, residency interview season is exciting. For others, it’s stressful and exhausting. But for me, more than anything else, the interview trail was inspiring.

I am currently applying to internal medicine-primary care programs and saw many of the same students at multiple interviews. In my conversations with other applicants, I was nothing but impressed by what these individuals had accomplished. I met students who had passed legislation, published numerous articles and had done important work domestically and abroad.

Primary care residency spots

In reflecting on the qualifications of my peers, I was saddened when I realized that it is likely that some of us may not match into a primary care program. In the 2013 match, there were 335 internal medicine-primary care positions, which were ranked by 2,165 total applicants. While many applicants also ranked non-primary care-internal medicine programs, there are clearly far fewer spots than interested applicants.

This demonstrates part of the problem in ensuring we have enough primary care providers to meet the needs of an aging, growing and increasingly insured population. The number of graduate medical education (GME) spots is a bottleneck in ensuring sufficient primary care physicians.

In 2010, the Council of Graduate Medical Education advised that the United States increase its proportion of primary care physicians to 40 percent. Simple math shows that the current distribution of residency positions makes this goal unachievable. Out of roughly 30,000 total residency positions in 2013, there are approximately 3,000 family medicine; 6,600 internal medicine; 2,700 pediatrics; and 1,300 obstetrics/gynecology positions. Nearly 90 percent of these residents would need to enter primary care to meet that 40 percent recommendation. In reality, fewer than 50 percent will serve as primary care physicians for any patient.

Thinking beyond increasing the number of providers

It is clear that we are not going to meet the need for primary care providers by training more physicians. For too long, we have tried to beat a dead horse by focusing on how we can improve the supply of physicians. But fortunately, increasing the number of physicians is not the only solution to address a problem that is likely to worsen this year by the influx of insured individuals.

The November 2013 issue of Health Affairs focused on the many other solutions available to address this workforce gap. For example, we can think about increasing the supply of other health care personnel, such as advanced nurse practitioners and physicians assistants. Other ideas include redistributing the patient load and workload to non-physicians, as well rethinking how and where care is delivered. Creativity is going to be required to address the shortage of primary care providers and the many other challenges that face our health care system.

Elaine Khoong is a medical student. This article originally appeared in The American Resident Project.

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  • ninguem

    It’s getting to the point where many of you will not match……PERIOD.

    We are approaching, maybe have already reached, the point where there are more graduates than residency slots.

    Wait ’till good solid qualified medical school graduates find they can’t place anywhere for postgraduate training. Won’t be long.

  • Patient Kit

    It’s good to hear that there are lots of current med students interested in going into primary care. Best wishes to you. I hope you find yourself in a residency position that you are happy in.

  • NewMexicoRam

    Another example of how government funding makes absolutely no sense.

  • PoliticallyIncorrectMD

    I wonder, if it wasn’t for self-proclaimed ACGME monopoly on approving residency programs, would some facilities be interested in starting programs independent of Medicare / government financing?

  • Margalit Gur-Arie

    I wonder why would anybody contemplate advanced training in a field that is to be “redistributed” to resources who don’t require any advanced training.

    • NPPCP

      I agree as far as family practice is concerned. Why?

  • upstream

    We should let Physician Assistants who have practiced FP for 5yrs sit for the Boards, since they have done the very same coursework & have the practical experience behind them. But the goverenment & schools have a roadblock in front of them there since one must be a graduate of an approved medical school (meaning DO or MD) even though these same medical schools have PA Programs. Also a MD/DO cannot sit for their exam, which is more comprehensive, since one must graduate from an approved PA Program to do so. The People are in Place to fill this incredible need, but simple beuracracy prevents it from being solved. There are only a few “Bridge Programs” from PA to MD & they still take another 3yrs of the same courses the PA have already completed & then they are placed into the required 3yr Residency in the area of their interest. They usually get the first openings in those residencies since they have done so well academically & also have proven their real world experience behind them.
    I don’t expect it to happen though since there are so many institutions with a vested interest in keeping the status quo. But, it is a thought.

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