Family Medicine Contributes Much More

Robert C. Bowman, M.D.

Family physicians stay active at 99%, in FP at 98%, in office primary care at 90%, and distribute outside of major medical centers with 57% (all others stay inside at 69%). Origins and distribution outside of major medical centers is the key to distribution with or without health policy support, however some support would be nice.

Rural born, lower income, middle income, and older students are more likely to distribute to rural and underserved locations. These distributional types of students are also more likely to choose family medicine. Even urban born and elite younger physicians distribute to rural and underserved areas at twice the rate of other physicians when choosing family medicine. (Birth Origins and Distribution Tables) Family physicians stay in family medicine and in office based primary care. The advantages are a likely result of different origins, different attitudes, different training, and a continual movement of family physicians away from major medical centers over the years after graduation.

Family physicians graduating from residency from 1997 to 2003 were still found in family medicine at 98% levels in 2005. Residency graduates in family medicine graduating after 1989 were found in office based primary care at 90% compared to 76% for pediatrics and 50% for internal medicine. Other primary care physicians and practitioners outside of family medicine are in a continuous transition away from primary care and toward major medical centers before, during, and after the completion of training.

For any significant contribution to physician distribution, physicians must escape the major medical center locations. Internal medicine and pediatric physicians concentrate in major medical centers (75 or more physicians at the same zip code) at 70% levels and compared to 40% for family physicians. In the most distributional medical schools such as Duluth and Mercer, only 24% of the family physician graduates have major medical center locations.  The schools with the most focus on family medicine distribute the most physicians, retain the most physicians instate to practice, and preserve the highest levels of office based primary care physicians.

All physicians can practice in the major medical centers that benefit from the most resources and helath policy support. Fewer can distribute to urban areas and very few can practice in urban underserved and rural locations. Underserved locations are zip codes associated with a whole county primary care shortage area, a community health center address, a National Health Service Corps site, county income levels in the lowest 6% in the nation, or a zip code population at the zip of 20% or more in poverty.

Outside of major medical centers, family physicians are the largest component in every other category with stellar contributions in rural and underserved areas. Family physicians also fill in the gaps in health care. Family physician contributions in mental health, women’s health, children’s health, and public health increase with the distance from major medical centers. Family physicians are retained in practice in the same state as their medical school at the highest levels of any discipline. The medical schools that admit the most elite students graduate the fewest family physicians and send the most investments in education and medical education to other states.

Family medicine is the only specialty that facilitates the distributional tendencies of humble origin students. Distribution in other specialties is limited to the levels of distributional type students: rural born, lower income origin, and older students. Rural born students have 22% rural choice. This increases to 46% for rural born family physicians. Rural distribution increases past 55% for Native American family physicians, for accelerated family medicine graduates, and for family medicine graduates in rural programs. Underserved location begins at 5 - 6% for all non-family physicians, doubles to 12% with choice of family medicine, increases to 26 – 28% for Black or Mexican American or lower income origin family physicians, and increases to 41% for Native American rural born lower income origin female family physicians. (Facilitating distribution)

As health policy, education, and admissions changes increasingly limit the commitment to patient care known as family medicine, the nation will suffer increasing shortages in rural and underserved areas. With the precipitous decline in choice of office based general internal medicine (also due to collapsing health policy), about 70% of the nation’s population will be face difficulties in access to medical care while the 30% of highest income levels and most urban origins will face few difficulties. Not surprisingly 70% of medical students share these elite origins and 74% of the students at the top 146 colleges also share the same origins. Until the nation puts a priority on child development, preschool, early education, and health policy improving access for all lower and middle income peoples; the nation will continue to suffer from infrastructure failures in health, education, public safety, economics, and other systems critical to the structure and function of the nation. Without these changes, the nation will not graduate family physicians or distribute physicians where they are most needed.

Physician Workforce Studies

www.ruralmedicaleducation.org