A robust family medicine workforce is critical to ensure that the American public has equitable access to appropriate and effective primary care. The AAFP recognizes the multifaceted and complex factors leading to specialty choice. Therefore, the AAFP calls on entities including, but not limited to medical schools, health systems, local and federal government, health care payers, nonprofit organizations, and private industries to develop and support programs and incentives that encourage student career choice of family medicine. These programs and incentives could be financial, educational, institutional, or political in nature.
The Four Pillars for Primary Care Physician Workforce Reform serves as a blueprint to identify the components needed to ensure sufficient growth in the number of primary care physicians (defined as family physicians, general internists, and general pediatricians). This model is used to organize the list below of program characteristics and initiatives known to increase student choice of family medicine into four pillars of pipeline, process of medical education, practice transformation, and payment.
Pipeline
Early exposure to family medicine and primary care
- Innovative educational programs for students from elementary school through medical school that provide age-appropriate mentoring and experiential learning from high-quality primary care physician role models.
- Formal engagement with local and regional premedical advisors.
- Pre-admissions programs or other experiential programs in primary care - examples include summer experiences, shadowing, and involvement in Area Health Education Centers (AHEC), Health Careers Opportunity Program (HCOP), and HOSA Future Health Professionals.
Medical School Admissions
- Medical school admissions policies that prioritize holistic applicant review and medical student diversity.
- Medical school admissions committees that recognize and value attributes found in primary care, appoint an adequate number of family medicine faculty as committee members, and include family physician interviewers as part of the admissions committee.
- Medical school admissions strategies that target students who are more likely to choose a family medicine career.
- Medical schools that actively engage, recruit, and prepare students underrepresented in medicine.
Outreach to Sustain Students’ Interest in and Ultimately Choice of Family Medicine
- Supporting medical school pathway and programs for students interested in underserved populations.
- Invest in family medicine student organizations (FMSO), such as family medicine interest groups (FMIG), American College of Osteopathic Family Physicians (ACOFP) student chapters, and non-family medicine-based groups that grow and diversify the family medicine workforce.
- Create FMIGs that maximize their influence, such as by participation in leadership and membership of students from all years, engaged FMIG faculty advisor(s), committed administrative staff for the FMIG, and FMIG collaboration with other interest groups that promote primary care.
- Maintain a mechanism for students to join the AAFP as student members.
- Develop longitudinal mentorship programs to connect students with family physicians throughout medical school.
- Expand opportunities to highlight family medicine's unique position and involvement in public health and advocacy efforts.
Measuring the impact of family medicine workforce development initiatives
- Create a strategic plan for student choice of family medicine within the family medicine department and monitor the progress.
- Mechanisms to measure the effectiveness and provide financial resources for initiatives that aim to increase student choice of family medicine.
- Quality improvement principles and practices to increase student choice.
- Federal and state policies that set expectations for medical schools to produce family physicians and accurately report their primary care physician production and distribution.
- Compare medical schools with a social mission and/or primary care mission to their production of family physicians.
Process of Medical Education
Addressing the hidden curriculum
- Systemic strategies to endorse positive perceptions of family medicine and promote family physicians as leaders within the institution.
- Advancement of model medical school curricula, governance and programming that lead to increased choice of family medicine.
- A standardized system to follow up with interested students following a family medicine clerkship, including regularly scheduled meetings between department chairs and medical students.
- Student exposure to prominent family physician leaders who are external to family medicine departments and academic health centers.
- Initiatives to promote the value of family medicine to non-family medicine faculty, medical school deans, and others influential leaders in the medical school and surrounding community.
Curriculum innovation
- Medical school accreditation LCME standards that should require family medicine exposureeducation early in medical school training.
- Advocate for family medicine clinical experiences that are shown to make a difference such as a required third-year clerkship, required fourth-year clerkship, elective rotation options, accelerated tracks, and longitudinal programs that allow students to experience continuity of care.
- Promote initiatives to expose students to family medicine role models and the full breadth of family medicine in hospital-based and ambulatory settings.
- Offer diverse clinical sites outside of the academic health center, including community-based practices, street medicine, direct primary care, and community health centers.
- Educate students about the social determinants of health and offer clinical exposure to under-resourced and vulnerable patient populations.
- Collect family medicine clerkship evaluations that capture meaningful data and are used to improve the quality of the rotation.
High-quality preceptors
- Provide resources, support, and training for family medicine departments and institutions to provide financial and professional incentives for community-based family physician preceptors.
- Encourage widespread enhanced support for family physician preceptor recruitment, development, and retention.
- Support the development of medical school family medicine alumni networks that serve as clinical training sites for medical students.
Adequate family medicine residency slots
- Graduate medical education modernization proposals that protect and expand funding for family medicine residencies.
- Initiatives to expand and fund rural training tracks.
Practice Transformation
Learners as part of interprofessional teams
- Integrated interprofessional education that includes students as an essential part of the team.
- Initiatives to expose students to medical home practices.
- Medical schools support a student run free clinic that focuses on primary care.
Family physicians as leaders within the clinical care team and as health equity champions for their communities
- Enhance medical school leadership development that prepares family physicians to be leaders in team-based primary care.
- Medical student experiences with family physicians who are self-employed and in solo practice.
- Rural health and global health experiences available to medical students, highlighting these opportunities within family medicine.
- Initiatives to expose students to population health, community service, and advocacy at the institution and community levels.
- Practice-based research on addressing health disparities.
Promote the value of primary care within the healthcare system to learners, patients, and communities
- Preservation of full-scope family medicine training and practice opportunities.
- Initiatives to expose students to health care reform, public health, and workforce policies.
- Initiatives to educate students on primary care’s role in improving quality and controlling cost of care in the healthcare system.
- Innovative research for primary care at all levels including quality improvement, comparative effectiveness, translational, and community-based participatory research.
- State and federal policies that selectively value a primary care-based physician workforce.
- Define and clarify the role of family medicine as a distinct and unique specialty within primary care.
Payment
Medical school debt
- Financial incentives that include scholarship programs and tuition waivers for students who commit to family medicine, medical student educational loan forgiveness programs, and low interest loan programs for family medicine residents and practicing physicians.
- Initiatives to direct students to federal and state loan repayment and scholarship opportunities.
- Initiatives to educate medical students and financial aid officers that family medicine is a financially viable career options, even for students with high debt levels.
Payment for family physicians
- Payment reform that appropriately values primary care.
- Faculty who are actively engaged in advocacy to address the physician payment gap.
(2006) (January 2022 COD)