While I waited on the telephone to make an appointment at my family physician’s office, I heard the recorded message: “We are no longer accepting new patients and we will no longer have extended hours until 7 p.m. on weekdays. We will be closed on Saturdays and Sundays.” The doctors in this practice were having difficulty recruiting new doctors to join them and were having to make tough decisions to restrict access to needed primary care.
Unfortunately, this is a national problem for the United States and is particularly acute in rural and poor inner-city areas. There is a shortage of adult primary care doctors (family physicians and general internists) as practices close to new patients and have long wait times for appointments. Nearly a third of Americans do not have a source of basic medical care and thus skip needed care or use an expensive urgent care center or emergency department.
Currently, only 12.6% of medical students enter family medicine residencies, according to data from the Society for Teachers of Family Medicine. The 2023 graduating class at Eastern Virginia Medical School had only 5% of medical students entering family medicine training programs (7 students out of 160).
Since family physicians currently comprise half of Virginia’s primary care workforce and provide care to adults and children, the need to train more of them is obvious. The American Academy of Family Physicians set the goal of 25% of U.S. medical school graduates choosing family medicine training by 2030 to meet the primary care health needs of an aging population. Clearly, more needs to be done to meet this goal.
The value of primary care is well known and documented. The Commonwealth Fund compares the health systems of wealthy countries and has shown that systems with at least 50% of doctors in primary care perform much better than in the U.S., which has only 30% of doctors practicing in family medicine, general internal medicine and general pediatrics. States that spend more on primary care have much better health outcomes and much lower costs, according to data from the Patient Centered Primary Care Collaborative.
The 2021 report, “Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care” from the National Academy of Sciences, Engineering and Medicine details the value of primary care and outlines strategies to bolster our faltering medical system. Providing a primary care medical home for all Americans and adequate reimbursement for these medical services are the report’s most important recommendations.
Local health systems are eager to hire graduates from the EVMS Family Medicine residency, knowing these doctors are trained in high-value, cost-conscious care. The residency provides some of the doctors to staff local offices, but demand is greater than the supply, particularly as many older doctors are retiring.
As EVMS and Old Dominion University work to merge (“Editorial: Promise of ODU-EVMS merger looms large for Hampton Roads,” June 3), part of the strategic plan should be to increase the number of medical students choosing to train in family medicine or general internal medicine. Loan repayment and forgiveness programs are effective recruitment tools and these programs should be expanded. The most powerful predictor of which students choose primary care is having a credible role model in that discipline with whom they can identify. Supporting those primary care doctors who serve as teachers for medical students should be a high priority. State legislative initiatives to increase Medicaid reimbursement rates and to limit administrative burdens would help make primary care a more attractive choice for medical students.
All of this will require smart strategic planning and coordination with multiple entities, but the goal of ensuring an adequate supply of primary care physicians should be an easily measured outcome. This will be an important investment in the future health of our population and a good way to lower health care costs.
Dr. Bob Newman is a clinical professor of family medicine at EVMS. He is the author of “Patient’s Compass,” which is a guide to navigating the U.S. health care system, available online at yourpatientcompass.com. Email him at [email protected] to order a paper copy.
