Family physicians call for more residency slots

By 2020, the American Academy of Family Physicians says the United States will need nearly 39% more doctors in their specialty than exist now.

The AAFP says the nation will need 139,531 family physicians by 2020 and has made a state-by-state breakdown of this estimate. There were 100,431 family physicians in 2004, according to data the AAFP compiled.

More primary care physicians have been needed for some time, but the problem has been exacerbated by an increasing population and a declining number of medical students moving into primary care, said Perry Pugno, MD, MPH, director of the AAFP's medical education division.

The AAFP is calling for family medicine residencies to expand from an average of 21 to 24 residents.

"We're going to need to graduate 3,725 family physicians each year by 2020 or we'll not meet that need, and more and more Americans will have difficulty accessing primary care," Dr. Pugno said. According to the AAFP, there were 3,617 family medicine graduates in 2006.

Dr. Pugno acknowledged that increasing the number of family medicine residents would be challenging in an environment where many of the specialty's existing residencies don't fill and some have closed down altogether. "We need the government to fix the way payments are done," he said.

The AAFP adopted the shortage estimate as policy during its annual meeting in the last week of September in Washington, D.C. The organization also confirmed existing policy that half of all primary care physicians should be family physicians.

To come to its conclusions, the shortage study took into account population growth, the increase of health risk factors of the population, the increase in the number of physicians opting to work part time, and an increase in physician productivity as doctors adopt new technology and more efficient practice models, according to family physician A. Peter Catinella, MD, MPH, lead author of the work force report, "Family Physician Workforce Reform: Recommendations of the AAFP."

Shortage expected in many specialties

The specialty-specific research helps flesh out the national physician work force shortage numbers produced by the federal advisory group, the Council on Graduate Medical Education, and others, said Edward Salsberg, director of the Assn. of American Medical Colleges' Center for Workforce Studies. These estimates forecast that the United States will be short anywhere from 85,000 to 200,000 physicians by 2020.

"It's important for each specialty to do their own planning," Salsberg said. "We think a whole range of specialties will be facing shortages."

For example, internists, cardiologists, child psychiatrists and geriatricians are among the specialties that have said shortages are looming.

The American College of Physicians has not estimated how many more general internists will be needed in the future, but ACP officials say a crisis in primary care is building as fewer internal medicine residents pursue primary care careers.

"Our data are much more general [than the AAFP's], but the generalities we're responding to are the same," said ACP President Lynne M. Kirk, MD. "We strongly believe work force analysis needs to be done by all disciplines working together to create a national work force policy."

Edward L. Langston, MD, RPh, chair-elect of the American Medical Association Board of Trustees, said in a statement that the AMA recognizes that there are physician shortages in many regions and specialties, including family physicians, and that evidence exists for additional shortages in the future.

"The AMA will continue to support those regions and specialties that have identified a need for more doctors," Dr. Langston said in a statement. "We will continue to work with state medical and specialty societies, as well as state and federal policy-makers, to develop and expand funding for graduate medical education in underserved areas and undersupplied specialties."

Meanwhile, Dr. Catinella and his colleagues will fine-tune their work, next focusing on a county-by-county breakdown of the nation's family physician needs.

"Very large metro areas overwhelm the aggregate [state] data," he said. "If we break it out county by county, the more rural areas have a greater weight in the total number. ... What we're trying to do that's unique is look at what's the need of the population based on demographics, socioeconomic factors and mortality."