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Update on the Physician Workforce August 2000
B. "INCREASING NUMBERS OF FAMILY PHYSICIANS-IMPLICATIONS FOR RURAL AMERICA"
The authors note that despite a sharp increase, starting in the mid-1960s, in the number of physicians per 100,000 population, the number per 100,000 engaged in family practice has remained relatively
constant, well below the levels deemed desirable by most physician workforce experts. COGME, as noted earlier, had recommended a minimum of 60 generalists per 100,000 population. In the judgment of the authors, the relatively low level of family practice physicians in this country, hovering in the neighborhood of 30 per 100,000 for the past thirty years, makes the attainment of even that minimum goal unlikely in rural areas where there are relatively fewer physicians in the other generalist specialties of general internal medicine and general pediatrics.
* 13. Overpeck MD. Physicians in family practice 1931-67. Public Health Rep 1970; 85(6):485-494.
On the positive side, the authors report a sharp rise (over 50 percent) in the number of family-practice residency graduates within the past decade. Applying the Health Resources and Services Administration/Bureau of Health Professions' Physician Supply Model to data extracted from the AMA Masterfile and from the Master File of the American Osteopathic Association, and making use of historic data concerning age- and gender-specific death and retirement rates, they projected that the number of family physicians providing active patient care in the United States (excluding residents and physicians over age 70) would increase from roughly 28 per 100,000 in 1997 to 34.4 per 100,000 in 2020.
This initial set of projections presupposes, however, that the rate at which physicians graduate from family practice residency programs remains at its present level of slightly under 4,000 per year, up from roughly 2,600 in 1992. In the interest of sensitivity analysis, the authors therefore postulated two alternative scenarios, one involving a short-term decrease in the number of family practice graduates produced, the other involving an increase. The results were as follows:
whereas
b. if the number were to increase at the rate of 200 per year for the next five years, the number of family physicians per 100,000 in the year 2020 would climb to approximately 40.
Turning to the issue of rural supply, the authors note that the number of family practice physicians per 100,000 is, if anything, slightly greater in small communities than it is in large ones. The difference, although small, makes sense: in smaller, rural communities, family physicians often must take the place of an internist or pediatrician who chose to practice elsewhere. Applying the Physician Supply Model once again, this time taking into account the rate at which family practice physicians, by gender, tend to practice in rural settings, the authors projected an increase in rural-based family practice physicians from the current level of 31.1 per 100,000 to 36.3 per 100,000 by the year 2020. They noted, however, that even an increase of that magnitude may not be sufficient to reach the COGME minimum, for all generalists combined, of 60 per 100,000.
The authors conclude by emphasizing that the recent upward trend in family practice residency graduates, and what it portends in terms of future supply, has favorable implications for rural areas as well as for the Nation as a whole. However, the authors note that interest in family practice appears to be diminishing and hospitals may have less motivation to maintain such residency positions because of reduced Medicare GME funding (This diminished interest may be evidenced by the results of the National Resident Matching Program (NRMP). Positions filled in family practice by U.S. medical students have declined from the prior year in each of the three consecutive years from 1998 to 2000.) The authors emphasize that in order for such growth to be sustained:
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