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Entry of US Medical School Graduates Into Family Medicine Residencies: 2013–2014

Stanley M. Kozakowski, MD; Philip W. Crosley, MBA; Ashley Bentley, MBA

Background and Objectives: This is the 33rd annual report prepared by the American Academy of Family Physicians (AAFP) that reports retrospectively the percentage of graduates from US MD and DO-granting medical schools who entered an Accreditation Council for Graduate Medical Education (ACGME)-accredited family medicine residency program and covers the period between July 2013 and June 2014. Approximately 8.5% of the 18,384 graduates of US MD-granting medical schools entered family medicine in 2014. Seventy of the 130 US LCME-accredited medical schools produced 80% of the graduates who entered family medicine. Schools that received public funding and schools with a department or division of family medicine had higher percentages of students selecting family medicine. Schools are ranked based upon a 3-year rolling average for the percentage of their graduates who entered family medicine. The West North Central, Mountain, and Pacific regions reported the highest percentages of medical school graduates who were first-year residents in family medicine programs (13.3%, 11.8%, and 11.8% respectively).

(Fam Med 2014;46(9):696-700.)

This is the 33rd national study conducted by the American Academy of Family Physicians (AAFP) that reports retrospectively the percentage of graduates from allopathic and osteopathic medical schools who enter Accreditation Council for Graduate Medical Education (ACGME)-accredited family medicine residency programs. The authors have used data from the annual census of these family medicine residency programs and the Liaison Committee on Medical Education (LCME) Annual Medical School Questionnaire Part II1 to analyze the US medical school origin of family medicine residents. Schools, states, and regions that have higher entrance rates into family medicine residencies may act as exemplars that can be used by stakeholders seeking to replicate their success.

 

Methods

 
 

One of the authors (PC) conducts an annual online survey of all ACGME-accredited family medicine programs. Nonrespondents were contacted by telephone and requested to complete the online survey. As in the past, a 100% response rate was achieved. Program data, including a list of all first-year residents, their medical school, and month and year of graduation constitutes the annual census of family medicine residency programs. All graduates of MD-granting medical schools who graduated between July 1, 2012 and June 30, 2013 were verified by the medical school registrar or in the case of non-respondents by using the American Medical Association (AMA) Physician Masterfile. Those who did not graduate between July 1, 2012 and June 30, 2013 were not independently verified. The American Association of Colleges of Osteopathic Medicine (AACOM) provided information on all graduates of DO-granting medical schools.2 The online census was used to determine the number of graduates from DO-granting medical schools that entered ACGME-accredited family medicine residencies. Data from the LCME Annual Medical School Questionnaire Part II was used to classify each US LCME-accredited medical school as public or private.1 The percentage of students entering family medicine residency in the same state as their medical school was calculated. Three-year rolling averages were created to report the number of graduates entering an ACGME-accredited family medicine residency from each US LCME-accredited school in recognition of the year-to-year variations that can occur. Information from the census and the LCME was used for a descriptive comparison to the data from the last AAFP census article published in 2013.3 Additional data regarding osteopathic students was obtained by personal conversation with Thomas Levitan, MEd, vice president for Research at the American Association of Colleges of Osteopathic Medicine. The residency census was granted an exemption from the AAFP Institutional Review Board.

 

Results

 
 

Type of Medical School

In 2013, there were 3,375 first-year residents entering into ACGME-accredited family medicine residencies. Almost half of all entering family medicine residents are from US LCME medical schools with the remainder split nearly equally between DO-granting schools and international medical schools (Table 1). A total of 859 graduates of osteopathic medical schools matched in family medicine through the AOA and the National Residency Matching Program matches in 2013, with an additional estimated 50–100 osteopathic students filling family medicine positions after the Match (July 2014).

Table1

Medical School Structure

The number of US LCME-accredited medical schools that had a graduating class rose from 126 in 2012 to 130 in 2013. Three of the four new schools are public. Public and private schools both increased the number of graduates entering family medicine, with the public schools outpacing the private schools. Schools with departments or divisions of family medicine produced a higher percentage of graduates entering family medicine residencies than those that lacked a division or a department. Two medical schools had a center for family medicine rather than a department or a division. Their rate of graduates entering family medicine residency programs fell between those schools that had a department or a division of family medicine and those that did not. (Table 2) 

Table2

Seventy of the 130 US LCME-accredited medical schools produced 80% of the graduates who entered ACGME-accredited family medicine residencies in 2013. (See “Number and Percentage of Medical School Graduates Who Were Family Medicine Residents by Medical School , 2013 at www.stfm.org/FamlyMedicine/Vol46Issue9/Kozakowski696.) 

Number and Percentage of Medical School Graduates Who Were Family Medicine Residents by US Medical School, 2013

Only four of the 130 (less than 5%) US LCME-accredited medical schools had more than 20% of their graduates matriculate into family medicine residency programs. In contrast to the MD-granting medical schools, 11 of the 29 DO-granting medical schools (approximately 40%) had more than 20% of their graduates enter into ACGME-accredited family medicine programs. (See “Number and Percentage of Graduates of Colleges of Osteopathic Medicine Who Were Residents in ACGME-Accredited Family Medicine Residencies, by US Osteopathic Medical College, 2013 at www.stfm.org/FamlyMedicine/Vol46Issue9/Kozakowski696.)

Number and Percentage of Graduates of Colleges of Osteopathic Medicine Residents in ACGME-Accredited Family Medicine Residencies-2

Three-Year Averages

The authors continued the tradition of utilizing a 3-year rolling average to determine which US MD-granting medical schools graduate a higher percentage of students into family medicine annually and created a rank-order list of medical schools by these percentages. This year, 17 of the schools in the top 20 are unchanged from the prior year (Table 3). However, three new schools appear in the ranks of the top 10 (University of South Dakota, Florida State University, and University of Wisconsin). It is notable that Florida State University, a community-based medical school, rose dramatically from number 27 last year to number 12 this year, with 20.4% of its 2013 graduates selecting family medicine.

Table3

Geographic Variation

The US census regions of the country show different graduation rates for family medicine-bound students (See “Number and Percentage of Medical School Graduates Who Were Family Medicine Residents by Census Region and State of Medical School, 2013 at www.stfm.org/FamlyMedicine/Vol46Issue9/Kozakowski696.)

Number and Percentage of Medical School Graduates Who Were Family Medicine Residents by Census Region and State of Medical School, 2013

Three regions (Middle Atlantic, South Atlantic, and East North Central) had the largest total number of medical school graduates. Although the percentage entering family medicine from these regions was relatively low, the absolute numbers were among the highest of all regions. Schools with the highest percentages of their graduates entering family medicine were from the West North Central, Mountain, and Pacific regions. Rates for MD-granting medical school graduates entering a family medicine residency in the same state varied significantly. Overall, 45.6% of students remained in the same state. However, there was marked variation among the states with the percent entering into family medicine residency in the same state as their medical school ranging from greater than 70% to less than 15%. (See “Percentage of 2012-2013 Medical School Graduates by State or Territory Who Entered a Family Medicine Residency Program in the Same State, 2013 at www.stfm.org/FamlyMedicine/Vol46Issue9/Kozakowski696.)

Percentage of 2012-2013 Medical School Graduates by State or Territory Who Entered a Family Medicine Residency Program in the Same State, 2013
 

Conclusions

 
 

The AAFP annual report on the entry of US students into ACGME-accredited family medicine residency programs again highlights that the percentage of graduates of MD-granting schools matriculating into family medicine remains low at 8.5%. In contrast, a survey of DO-granting medical school graduates found that more than 20% intend to enter a career in family medicine.4 If 20% of US MD-granting graduates matriculated into family medicine, that could result in an additional 2,129 family physicians per year.

As in 2012, almost three-fold as many graduates from public MD-granting medical schools entered family medicine residencies in 2013 than graduates from private schools. (See “Number and Percentage of Medical School Graduates Who Were Family Medicine Residents by Type of Medical School , 2013 at www.stfm.org/FamlyMedicine/Vol46Issue9/Kozakowski696.)

Number and Percentage of Medical School Graduates Who Were Family Medicine Residents by Type of Medical School, 2013

Previous articles in this series have highlighted significant regional differences in the percentage of MD graduates entering into family medicine residencies. Higher percentages of allopathic graduates entering family medicine were found in the regions west of the Mississippi River. However, the number of overall US LCME graduates and those entering family medicine are higher east of the Mississippi. Even within most regions, there is significant variation by state and medical school. This suggests that other factors may play a greater role in influencing a student’s career choice.

The AAFP sponsored a series of regional family medicine stakeholder meetings in 2010 and 2011 that resulted in the creation of a model to increase the number of medical students who select a career in family medicine. This model acknowledges that a variety of factors may influence the specialty choice of an individual student. These factors include the payment system and perceived future earnings, influential people, local and national policies that impact family medicine, programs that impact premedical and medical students, positive and negative perceptions of family medicine, and the personal characteristics of the student.5 Certain medical school features, such as having a department of family medicine, appear to make a significant difference in influencing student choices. However, the fact that some schools have a department of family medicine but graduate few or no students entering into family medicine suggest that the reasons for choosing family medicine are more complex. Previous data have shown MD graduates from regional medical campuses (RMC) enter family medicine at a higher rate than their counterparts from non-RMC.6 Although high educational debt may be a factor for some students not to choose a family medicine career, indeed it may dissuade some students from even considering a career in medicine, it is unclear how to reconcile the fact that more graduates from DO-granting schools select family medicine while having a higher mean level of medical school debt than their MD counterparts ($211, 423 versus $169,901).4,7 It is unknown if, among the DO students, there is a correlation between debt level and career selection.

There are important limitations with this study. ACGME-accredited programs represent only one avenue for graduate medical education for those graduating from DO-granting medical schools. This study only examines graduates who enter ACGME-accredited family medicine residencies and does not include graduates entering residencies accredited only by the American Osteopathic Association (AOA). There are currently 227 AOA-accredited family medicine programs, 99 of which are also accredited by the ACGME.8 Residents self-identify where they have graduated medical school. All graduates are aggregated as listed under the accredited MD programs within the LCME Medical School Directory. Only those who graduated from an MD-granting school between July 1, 2012 and June 30, 2013 were verified by the medical school registrar or in the case of nonrespondents by using the AMA Physician Masterfile.

This study is not designed to distinguish the training experiences between graduates of the same medical school despite significant differences such as training on a RMC. One can speculate that the focus on community-based training in DO-granting schools, perhaps similar to that which takes place at RMC sites, may be a reason for the higher interest among DO graduates to enter into a family medicine residency program.

This study highlights the overall failure of the current US LCME-accredited medical schools to meet the current need for primary care physicians to serve the population as recommended by the 20th COGME report. Population growth, the aging population, and increased accessibility to insurance through the Affordable Care Act are expected to increase the demand for an additional 52,000 primary care physicians by 2025.9 The AAFP and the Council of Academic Family Medicine organizations created a simple framework supported by four pillars to clearly communicate the factors and prioritize those activities that impact the primary care physician workforce.10 The pillars include efforts to increase the pipeline by identifying, recruiting, and retaining students and residents into primary care; ensure that the process of medical education trains physicians to practice evidence-based, compassionate, and comprehensive primary care; expose learners to transformed practices based on the patient-centered medical home model of care; and advocate for payment reform to address the need for appropriate reimbursement of primary care practice. These four pillars are interdependent and taken together can change the current trajectory of primary care production of medical schools. There are bright spots where medical schools are graduating more students into family medicine careers. They should serve as exemplars to the rest of the field. Courage and political determination will be necessary to change the current trajectory of the family physician pipeline.

Corresponding Author: Address correspondence to Dr Kozakowski, American Academy of Family Physicians, Medical Education Division, 11400 Tomahawk Creek Parkway, Leawood, KS 66211. 800-274-2237, ext. 6700. Fax: 913-906-6289. skozakowski@aafp.org

 

References

 
 
  1. Barzansky B, Etzel SI. Medical schools in the United States, 2012–2013.JAMA 2013;310(21):2319-27.
  2. American Association of Colleges of Osteopathic Medicine. Applications, enrollment and graduates by osteopathic medical colleges. www.aacom.org/data/studentenrollment/Documents/2008-2013_AppEnrollGrad.pdf. Accessed July 9, 2014.
  3. Biggs WS, Crosley PW, Kozakowski SM. Entry of US medical school graduates into family medicine residencies: 2012–2013. Fam Med 2013;45(9):642-6.
  4. AACOM 2012-13 Academic Year Survey of Graduating Seniors Summary Report. http://www.aacom.org/data/classsurveys/Documents/2012-13-grad-survey.pdf. Accessed July 9, 2014.
  5. American Academy of Family Physicians. Student Interest Portfolio. www.aafp.org/siportfolio. Accessed July 9, 2014.
  6. Liaw W, Cheifetz C, Luangkbot S, Sheridan M, Bazemore A, Phillips RL. Match rates into family medicine among regional medical campus graduates, 2007–2009. J Am Board Fam Med 2012;25(6):894-907.
  7. Association of American Medical Colleges. Medical student education: debt, costs, and loan repayment fact card. October 2013. https://www.aamc.org/download/152968/data/debtfactcard.pdf.
  8. AOA-Approved Postdoctoral Training Online Directory. http://opportunities.osteopathic.org/search/search.cfm. Accessed July 9, 2014.
  9. Petterson SM, Liaw WR, Phillips RL Jr, Rabin DL, Meyers DS, Bazemore AW. Projecting US primary care physician workforce needs: 2010-2025. Ann Fam Med 2012;10(6):503-9.
  10. The Four Pillars for Primary Care Physician Workforce Reform. The four pillars for primary care physician workforce reform: a blueprint for future activity. Ann Fam Med 2014;12(1):83-7.

From the Medical Education Division, American Academy of Family Physicians, Leawood, KS.


Copyright 2017 by Society of Teachers of Family Medicine