In 2019, a Policy One-Pager produced by the Robert Graham Center reported that the percentage of the active U.S. physician workforce in primary care practice declined from 32 percent in 2010 to 30 percent in 2018. Although family physicians represent 4 in 10 primary care physicians, in several states, a large percentage of family physicians are older than 55 years and anticipated to transition to part-time practice or retire by 2030. The immediate prospects for replacing them are poor. Graduates of 14 U.S. allopathic medical schools that were newly accredited since 2002 and had at least one graduating class by 2015 were actually 40 percent less likely to enter family medicine than graduates of the 118 previously existing schools.
Recognizing the imperative to not only maintain, but expand the family medicine workforce to meet the population’s needs, the Workforce and Education Development team of Family Medicine for America’s Health recommended adoption of a shared aim known as 25 x 2030: to increase the percentage of U.S. medical students choosing family medicine from 12 percent to 25 percent by the year 2030. Supported by the American Academy of Family Physicians and seven other national and international family medicine organizations, the America Needs More Family Doctors: 25 x 2030 collaborative was officially launched in August 2018.
In an editorial in the January 15 issue of American Family Physician, Dr. Jacob Prunuske, a member of the 25 x 2030 Steering Committee, described the collaborative’s guiding principles, benefits to physicians at all levels of experience, and how family doctors in the trenches can support progress toward this ambitious aim:
Recruit before medical school. Encourage children and young adults to not only go to medical school, but to become a family doctor. Active recruitment is especially valuable in underserved or rural communities and for those underrepresented in medicine.
Change the medical school experience. When you have the opportunity to work with medical students, say yes. If you must say no, reflect on what it would take to get you to say yes, and share your reflections with your health care system, institution, or the 25 × 2030 working groups so that they can address barriers to teaching. As preceptors for medical students, family doctors not only teach family medicine principles, but also serve as mentors and role models. Embrace this role. Debunk myths and counter negative stereotypes of family medicine. Family doctors provide high-value care by delivering high-quality outcomes while controlling costs. Medical students need this experience with practicing family doctors to combat the alternative messages of other specialties.
Advocate for family medicine. Legislative leaders need to hear about the value of family medicine from voters. Respond to advocacy calls, and advocate at the local, state, and national levels for changes that support family medicine. Share your advocacy efforts with your patients and tell them why these issues matter to you, them, and all of us.
Embrace change. Patient expectations, technology, and health systems will evolve. Rather than react, help guide these changes to fit the principles of family medicine.
An excellent resource for interested medical students is a 2016 AFP article, “Responses to Medical Students’ Frequently Asked Questions About Family Medicine,” which answers common questions about the importance of the specialty, residency and fellowship training, procedural skills and scope of practice, economic realities, and future prospects. The article advised students that “the best way to know if family medicine is the right fit for you is to work with family physicians in action, by doing a rotation with a family physician in practice.” The trouble with this advice, though, is that a lot of my colleagues are unhappy or just plain miserable, worn down by caring for too many patients in too little time and being consumed by tedious “desktop medicine” tasks rather than the face-to-face interactions that are the reason they went into primary care in the first place. To recruit more students into family medicine, we will need to make dramatic changes to unhealthy and unsustainable work environments.
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