Aug. 15, 2024

By Steven Furr, M.D., FAAFP
AAFP President

During the recent National Conference of Family Medicine Residents and Medical Students, mainstage speaker J. Nwando Olayiwola, M.D., M.P.H., FAAFP, talked to future family physicians about the importance of leadership.

Notably, Olayiwola said it’s not enough to merely accumulate followers; effective leaders must be thoughtful and intentional about where they lead people.

So, where are we headed?

For 50 years, National Conference has given students and residents opportunities to learn, lead and connect. The more than 1,600 students who attended the event this year heard advice about the Match process in educational sessions, met with hundreds of residency programs in the Expo Hall, learned leadership and advocacy skills in the student congress, gained hands-on experience in a number of procedural workshops and had a chance to meet like-minded peers in member interest group meetings.

In short, they got a taste of family medicine that hopefully will leave them hungry for more. Our specialty faces challenges on many fronts, but it’s also true that patients need us now more than ever.

An Association of American Medical Colleges report released earlier this year stated that the United States faces a projected shortfall of 20,200 to 40,400 primary care physicians by 2036. That means the nation needs a lot more family physicians, because primary care is family medicine and family medicine is primary care.

A recent Medscape commentary by a veteran internist mourned the death of primary care in internal medicine. Although it might sound like hyperbole, the statistics are alarming. By one estimate, the percentage of internal medicine residents choosing to subspecialize, rather than practice primary care or hospital medicine, skyrocketed from 61.5% in 2018 to 87.6% this year.

Although other medical professionals have been heralded as a solution to the primary care shortage, nurse practitioners and physician assistants also are increasingly being drawn to subspecialty fields. About one-third of nurse practitioners work in primary care, and the number is even lower for PAs.

Pediatrics experienced a sizable drop in its Match rate this spring, leading the authors of a recent JAMA article to question, Where Are All the Pediatricians?

I don’t know the answer to that question, but I do know where the pediatricians, OB/Gyns and many other specialties aren’t practicing. Many rural and underserved areas can’t support pediatric and obstetrics practices because those specialties need a large population of specific groups of patients to thrive.

Family physicians have no limits on who we can see, which means there are few limits on where we can practice. We can treat patients of any age and gender, which means we can fill the gaps in communities that lack pediatricians and OB/Gyns.

Rural and underserved areas also have great need for addiction medicine, and the broad scope of family physicians training covers that, too.

Multiple studies have found that primary care reduces health care costs and improves outcomes. Unfortunately, 25% of Americans don’t have a relationship with a primary care clinician, family doc or otherwise. Even some urban areas are now considered underserved, and many patients can no longer find a family physician.

But every American should have a family physician.

Every American deserves a family physician.

If we could accomplish that, everyone would have better health care (and lower costs). With equal access to high-quality care, maybe our health might be less influenced by our ZIP codes.

The challenge of addressing the primary care shortage will require action on multiple fronts, including continued advocacy for improved reimbursement and expanded residency slots for family medicine.

In its annual review of physician recruitment, AMN Healthcare reported that family medicine topped the list of physician search engagements for the 18th year in a row. The same report found that the average starting salary for family docs increased more than 6% to $271,000.

(The AAFP’s Career Benchmark Dashboard, where more than 7,500 members have contributed data, produced a slightly higher number with an average of $274,359 for full-time family docs.)

But another key step is ensuring students see the myriad possibilities in family medicine. Students who came to National Conference this month got a glimpse of obstetrics in family medicine and sports medicine in workshops, and they heard about direct primary care in educational sessions.

Although that was a powerful experience, imagine how much more they could see and experience in our clinics with real patients who need real care.

If we become the people we want to be, the physicians we should be, students and residents will come to us. When they do, where will you lead them?