The Return of the Family Doc?

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After years of declining interest in family medicine, some new numbers show more medical school graduates are gravitating toward primary care.

Family medicine practitioners and proponents haven't had much to cheer about in recent years as a shrinking number of medical students have gravitated toward the field, which is often viewed as a poor stepchild to big money, lifestyle-friendly specialties like plastic surgery, radiology, and cardiology. But for the first time in 10 years, there is a budding interest in family medicine among fourth-year medical students. The nonprofit National Resident Matching Program in March showed that 1,172 U.S. medical school seniors—65 more than in 2007—chose family medicine. Family medicine achieved a 91% fill rate for residencies, the highest in more than 10 years, with 2,404 of the 2,653 family medicine residency programs nationwide filled by U.S. medical school graduates. In addition, 33 new family medicine residencies were offered nationwide.

This might not represent a sea change in how family medicine is viewed, nor will 33 new residencies make much of a dent in the nation's critical shortage of primary care physicians. But family medicine advocates say it's a good start.

"We have a long way to go," says Ted Epperly, MD, president of the American Academy of Family Physicians. "It's far from over, but all the needles are moving in the right direction in terms of stopping this skidding."

Epperly, who is also CEO of the Family Medicine Residency of Idaho in Boise, says the latest numbers constitute "more than a one-year blip."

"Family medicine interest groups in all of the 126 university medical schools have more students in those interest groups than we've ever had. So the pipeline is full of more and more interested kids," he says. The market for family practice physicians appears to be growing. The physician recruiting firm Merritt, Hawkins & Associates reports in its 2008 Review of Physician Recruiting Incentives that "family practice physicians" was its most requested search. The Irving, TX-based recruiter conducted 492 family practice search assignments in 2007-08 compared with just 166 in 2004-05, and the number of search requests grew 62% from 2007 to 2008.

"Six or seven years ago, family practice was pretty much a recruiting afterthought," says Phil Miller, vice president of communications at MHA. "Now family practitioners have gone to the top of the wish list for many hospitals."

So what happened?

Epperly says medical students are a savvy bunch. Their newfound interest in family practice medicine reflects their understanding of what is going on in the real world of healthcare delivery. "They are becoming more and more aware of our broken healthcare system," Epperly says. "They are recognizing what many people are calling for in terms of healthcare's restitution is a promotion back to a strong primary care base, where primary care physicians are at the center of that system."

The renewed interest and demand for family physicians has been reflected in the paycheck, as well. MHA reports that the average salary for a family practice physician grew from $150,000 in 2004-05 to $172,000 in 2006-07.

Hospitals are paying more for primary care physician-employees, and hospitals are paying more for the primary care group practices they're purchasing, Epperly says. On the fee-for-service side, he says, Medicare has increased reimbursements on its service codes for primary care, and there is growing interest in the patient-centered medical home model, with the accompanying care management fees that will provide additional income for family physicians.

"When all is said and done, family docs have been underpaid and undervalued in the system," Epperly says. "People are recognizing that we have gotten way off track, overpaying for high-end specialists and procedures that are way overvalued for cost and even outcomes."

John Commins

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