Family medicine sees small gains in filling residency positions

Family medicine gained 26 residents in the March 2006 match, according to preliminary information from the National Resident Matching Program. Of 2,727 residency positions offered in family medicine, 2,318 positions were filled – an 85 percent fill rate. This is the third year of relatively small increases for the specialty. Family medicine saw large increases between 1993 and 1997, followed by large decreases between 1998 and 2003.

Of those students who matched in family medicine in 2006, 1,132 were U.S. seniors. This is the same number as in 2005; however, the number of family medicine positions filled by U.S. seniors has gradually decreased since 1997, when it peaked at 2,340.

How other specialties fared

The other primary care specialties saw relatively little change in the 2006 match. Internal medicine-primary gained four positions, internal medicine-pediatrics gained four positions and pediatrics-primary lost one position. Together, these three specialties gained just seven positions, with 26 more positions filled with U.S. seniors.

Anesthesiology and emergency medicine saw some of the biggest gains with 100 and 53 new positions, respectively. Obstetrics-gynecology gained 47 positions.

The bottom line

Overall, of 20,072 applicants who selected residencies through the Match this year, only 3,032 chose primary care programs. The trend toward specialization, which is likely driven by increasing student loan debt and income expectations, could result in “an increasingly fragmented, over-specialized and inefficient system,” says Larry S. Fields, MD, president of the AAFP.

“Family medicine is an integral part of the solution to providing high-quality, affordable and accessible health care to everyone,” says Fields.

Work setting affects physicians' quality of work life

Are family physicians happier with the quality of their work life in private practice or employed practice? Researchers recently tackled this question (see the November/December 2005 issue of Annals of Family Medicine;http://www.annfammed.org/cgi/content/full/3/6/500) and found that independent family physicians tended to work longer hours, worked in smaller groups, and had been in practice and in their current setting longer than the employed family physicians. Independent family physicians were also happier with their work relationships, their family time, their influence over management decisions and their quality of care. They were also more satisfied with their career choice, felt they had greater ability to achieve professional goals, and were less likely to have plans to leave the practice.

Researchers concluded that health care organizations will need to address these work life issues if they hope to create a satisfied and stable physician workforce.

Physicians urged to prepare now for 2006-2007 flu season

To help ensure that physician offices are prepared to handle patient demand during the 2006–2007 flu season, the AAFP and other organizations are advising that physicians order their inactivated influenza vaccine now. Sanofi Pasteur, the only manufacturer that sells directly to practices, has reportedly pre-booked all of its influenza vaccine supply (except pediatric doses) planned for the next season. However, practices can still place influenza vaccine orders with the companies listed below, which have been identified as distributors by the manufacturers.

Even practices that order early could face difficulties obtaining enough vaccine if last year’s manufacturing and distribution problems continue. To reduce such problems, the AAFP suggests that family physicians divide their order to obtain vaccines from multiple manufacturers, rather than relying on a single company. Family physicians may also benefit from group purchase arrangements that may be available through hospitals, nursing homes or other organizations. A list of group purchasing organizations can be found at http://www.higpa.org/member_orgs/Member_Orgs.asp.

Practices may also be able to obtain vaccine from sources such as the Vaccines for Children (VFC) program (see http://www.cdc.gov/vaccines/programs/vfc/providers/ for information on becoming a VFC provider).

Coalition aims to reduce physicians' administrative hassles

A coalition formed recently to identify strategies to simplify the administrative paperwork associated with operating a medical practice is gaining support. The Healthcare Administrative Simplification Coalition (HASC) is led by the AAFP, the American Health Information Management Association and the Medical Group Management Association (MGMA) and now includes members such as the American College of Physicians, Humana and Microsoft.

“Much of the waste generated in our system is a result of administrative busywork or redundancies that add no value to the patient, provider or payer,” says William F. Jessee, MD, president and CEO of the MGMA.

Data from the MGMA Center for Research indicates that administrative tasks for a 10-physician group can cost almost $250,000 annually.

So far, the coalition has supported initiatives to use a standardized online credentialing process and to develop operating rules to ease verification of patients’ insurance coverage (see http://www.caqh.org). It has also endorsed a project to make patient financial communications clear, concise, correct and patient-friendly (see http://www.patientfriendlybilling.org).

99214s on the rise

The percentage of established-patient office-visit services coded as 99214 by family physicians under Medicare has increased from 20 percent in 2002 to 25.6 percent in 2004, according to data from CMS. The percentages for codes 99212 and 99213 have decreased.