Kalaki M.Clarke, MD
The health care road has been less than smooth on the family physician’s journey towards optimizing America’s health. Nevertheless, I’m optimistically looking down that road and believe that 10 years from now, many of the present potholes will be filled in and many flashing red traffic lights will be repaired.
One of the main potholes in the health care road that I foresee being repaired is the family physician deficit. Currently, one-third of physicians provide primary care while more than half of all clinical visits are in primary care offices. Clearly, this particular dip in the road begs reconstruction. How do we fix this? Repair begins when family physicians fully take full pride in our responsibilities as the cornerstone of American health. Our demonstrated passion as comprehensive care providers for patients from the womb to the tomb will draw the next generation of physicians to family medicine as their vehicle of societal contribution. Medical students will inevitably be compelled to join us for the ride and contrary to popular impression they’ll discover that we see more in our clinics than the self-limited rhinovirus. They will then be less lured by the fancy and shiny specialty-driven vehicles currently advertised as the sole solution to professional fulfillment.
As our workforce increases, down the road the disproportionate 2:1 specialist to primary care provider ratio will reciprocate. We are actually headed in the right direction evidenced by NRMP (National Residency Match Program) stats showing that 95% of family medicine training positions were filled in 2016 compared to 85% in 2006.
What about some of those flashing red traffic lights presently stalling our journey’s advancement? One of the largest of these is the one that fails to value the practice of primary care. An associated roadblock includes the imbalanced manner in which family physicians are financially compensated. On my recent sports medicine rotation I was taken aback when my attending shared with me that the encounter time we spent as consultants would have been reimbursed triple the amount had we served as primary care providers managing multiple chronic conditions.
Although that was a disturbing realization, I was filled with renewed appreciation for family medicine when I learned from the AAFP Immediate Past President, Wanda Filer, MD, that the death rate decreases in communities with family physicians. Intrigued, I investigated further and found literature that cited National Institute of Health (NIH) studies published in the 1990s which proved that US states with higher ratios of PCP to population had better health outcomes including lower rates of all cause mortality from heart disease, cancer, and stroke. All of these outcomes were independent of the highly relevant social determinants of health. If that information doesn’t scream “high value” with the potential to achieve the Triple Aim (and even the Quadruple Aim), please tell me what does.
By David Anthony, MD, MSc, Alec Chessman, MD, Kristina Duarte, MD, ScM, Katie Margo, MD, of Medicine Jacob Prunuske, MD, MSPH, and Martha Seagrave, PA-C.
This is in response to a previous blog post, How Faculty Can Prepare Students for the Match.
In an effort to address the increasing challenge of assisting students in obtaining family medicine positions in the Match, Michelfelder et al recently published a set of recommendations derived from discussions at sessions presented at the Society of Teachers of Family Medicine (STFM) Conference on Medical Student Education (MSE) and the Association of Departments of Family Medicine Conference. We commend the authors on their important work, and we support many of their recommendations, including:
- Encouraging increased communication between medical school advisors and program directors
- Discouraging students who do not “see themselves as thriving as family physicians” from applying to family medicine programs
However, we take issue with one of their recommendations, and pose an alternate viewpoint.
The authors state that “Most clerkship directors recommend students apply to 20–40 programs to increase interview offers.” While this statement may represent the prevailing voiced opinion during the lecture discussion at MSE, we take issue with the claim that most clerkship directors recommend students apply to 20–40 programs, and we vigorously disagree with the recommendation. Broadly encouraging students to apply to such a large number of programs will worsen the challenges of students in obtaining interviews and residency positions.
By Aaron Michelfelder, MD; Joel Heidelbaugh, MD; Cristen Page, MD, MPH, and Eva Bading, MD
Read the response to this blog post, Too Much of Anything Is Bad: Advising Students on the Number of Programs to Apply to.
As matching into all specialties has become more challenging in the last few years for US medical students, it is important to provide the most timely and accurate advice to those considering family medicine.
Several confounding factors contribute to a more challenging match into family medicine as a primary specialty choice:
- Medical school class size has increased, and new schools have been formed without any increase in residency positions.
- There is an increase in US citizens who are international medical students and who are entering the residency Match pool.
- Medical specialties are becoming more competitive, and students at risk of not matching into their primary specialty choice are creating parallel plans.
- Fourth-year medical students apply to two or three different specialties, which results in more students applying to family medicine, many of whom are highly competitive and have high USMLE scores.
- Students who in the past would have been offered many interviews are being offered fewer due to the influx of parallel plan students flooding the family medicine applicant pool.
- Programs are placing a higher emphasis on USMLE scores as a method of predicting the possibility of passing the ABFM board exam.
- National Residency Matching Program All In Policy means that more residency slots are filled during the Match, and fewer are available for the Supplemental Offer and Acceptance Program, or SOAP (formerly called “the scramble”).
We recently hosted lecture-discussions on matching into family medicine at the 2014 Society of Teachers of Family Medicine Conference on Medical Student Education and the 2014 Association of Departments of Family Medicine Conference and have collated the thoughts and recommendations of these national discussion participants with advice to students wishing to match into family medicine as listed below.
1) Students should pass and perform well on USMLE Step 1 on the first attempt. It is better to delay clinical clerkships and graduation than to fail Step 1. Some residency programs use the average Step 1 score (around 220) as a cutoff for interview invitations.
2) Students should work hard and perform well on clinical clerkships. International medical students understand that performance on clerkships can help with getting a residency spot, so US medical students can sometimes be overshadowed by very capable and hard-working international medical students. US medical students are competing more than ever against many talented and competitive US and international medical graduates.
Posted in Education, Match, Medical School, Residency
Tagged board exams, educators, Family Medicine, how to get into residency, how to match into family medicine, match, medical school testing, Residency, STEP, students