As the demand for physicians increases across the United States, new research predicts our nation will continue to experience a primary care physician shortage, leaving rural and underserved communities with wide-ranging health issues and aging populations most vulnerable.  

In an effort to understand these disparities in the physician workforce, faculty members from the University of Minnesota Medical School, Duluth Campus have participated in a first-of-its-kind, comprehensive multi-institutional study, which is showing that U.S. medical schools are overestimating the number of graduates who will enter the primary care workforce. To determine their estimates, most schools use the sum of the graduates who matched into internal medicine, family medicine, pediatrics, and internal medicine/pediatrics.

However, Department of Family Medicine and Biobehavioral Health faculty, Emily Onello, MD, assistant professor, and James Boulger, PhD, Distinguished University Teaching Professor, along with Patrick Bright, MA, discovered that medical school graduateswho match into and complete a family medicine residency are much more likely to actually practice in a primary care setting compared to the other primary care specialties of internal medicine or pediatrics. 

“Over the last 50 years there’s been an increased movement away from the general practice of medicine, whether it be family medicine, internal medicine or pediatrics to more specialized areas of medicine,” Dr. Boulger said. “Primary care physicians are the gatekeepers for the majority of our healthcare issues, but we don’t have enough of them.”

Study Findings

The study evaluated over 17,000 physician alumni from 14 university systems across the country between 2003 and 2014, so that time would allow for the completion of residency and into practice. Using the Residency Match Primary Care Method compared to the research team’s new Intent to Practice Primary Care Method, the team found that nearly half of the MD graduates who identified as primary care did not end up practicing in primary care. 

“Maybe we really need to be looking into each specialty rather than combining them all together,” Dr. Onello said. “It’s a major concern for our nation’s wellbeing. The need for more accurate outcome studies like this is critical to public health and medical school education. The COVID-19 pandemic has elevated awareness for the need to have physicians in locations where they can respond to unanticipated events." 

Solutions for the Future

For rural and underserved communities, primary care physicians are critical in treating a wide range of health issues, while offering lower-cost healthcare and longitudinal relationships with patients over time. 

“We don’t have a data system that emphasizes primary care, preventative care, socioeconomically appropriate care,” Dr. Boulger said. “We simply don’t have that.” He also emphasizes that remote locations are not likely to support the full-time practices of sub-specialty physicians. 

Driven by the unique mission and success of the Duluth campus to educate physicians dedicated to family medicine and to serve the needs of rural Minnesota and Native American communities, the team strongly recommends that similar pathways be supported by more U.S. medical schools to strengthen the future of the physician workforce.

“This is an ever-evolving study,” Bright said. “Follow-ups are going to be needed at certain time intervals to see if the primary care workforce trends are going up, down or staying steady.”

Right now, the team is working strategically to expand research from the study that focuses more on rural and Native American populations, where the shortage of primary care physicians has been most chronically felt. The team encourages all U.S. medical schools to adapt and contribute more detailed data to better the derived predictive methodology.