Family Physician Workforce Development: American Academy of Family Physicians Models and Workplans Amy L. McGaha, MD, FAAFP Ashley DeVilbiss Bieck, MPA June 23, NAO Conference Las Vegas, NV

Objectives Review the 2009 AAFP Workforce Policy statement, summary recommendations, and advocacy priorities. Provide participants with an update about the AAFP ’ s Medical Education activities. Educate audience about available AAFP Student Interest resources.

In 1961, half of U.S. physicians were generalists. AAFP agrees with COGME recommendation 50/50 ratio. Demographic changes require more family physicians. Rural physician supply has not improved since first shortage identified in The increasing generalist-specialist imbalance undermines the nation ’ s ability improve access. Background

Assumptions: -Current system is characterized by high cost and poor outcomes. -Health care reform discussion must include workforce policy. -Primary care foundation is essential to efficient, effective, and equitable care. -We must strengthen the primary care base. Background

Colwill predicted that population growth and aging will result in a deficit of up to 44,000 adult care generalist physicians by Class size expansion and new medical schools. September 2008 JAMA: Only 2 percent of medical students planned to pursue general internal medicine. GME training is decreasing for general pediatricians, general internists, AOA and ACGME trained family physicians. Background

"The United States is experiencing a primary care shortage the likes of which we have not seen. The demand for primary care in the U.S. will grow exponentially as the nation's supply of primary care dwindles." –Jeffrey P. Harris, MD, FACP –President, American College of Physicians –Testimony to the House of Representatives Energy & Commerce Health Subcommittee –March 2009

Physician Demographics There are approximately 800,000 physicians in the US. There are 269,000 (34%) primary care physicians (FM, IM, Peds, geriatrics)

Sufficient FP Workforce Depends on: Sufficient Recruitment Appropriate Training Continued Retention A practical approach to workforce: The Three-Legged Stool

-Adopted by the AAFP in September/October Last AAFP Workforce Policy statement adopted AAFP Commission on Education process began May Collaboration with Robert Graham Center. -Workforce Advisory Panel (ADFM, AFMRD, STFM reps). Background

Summary Recommendations National Workforce Planning Funding/New Financial Models Medical School Expansion Delivery Systems Access Community Health Centers Geriatrics International Medical Graduates

Focus on Recruitment, Training, and Retention. --Acknowledge workforce trends of other healthcare disciplines. --Acknowledge socioeconomic trends that influence access. --Acknowledge demographic trends.

AAFP Division of Medical Education Two Priorities: Support student education Support resident education

National Conference of Family Medicine Residents and Medical Students Clerkship Directory Premed/ College Practice M1 M2 M3 M4R1 R2 R3 Fellowship FMCR Project Residency & Fellowship Directory Pre-Doctoral curriculum NRMP Reports Fellowship Directory RPS Workshop for Faculty and Staff Program Directors’ Workshop RPS Calendar FMIG Network Open Positions Listing Virtual FMIG

Multiple Complex Factors Admission Practices Medical School Mission Socioeconomic Status Personality Gender Age Marital Status Geographic Background Academic Background Career Intentions Values and Knowledge of Students Ethnicity Medical School Experiences Premedical Pipeline Lifestyle Debt Role Models & Mentors Legislative Mandates Income Dept Structure Educational Experience Preclinical Curriculum Required FM Clerkships Primary Care Tracks Faculty Competency Hidden Curriculum Type of Med School

Medical Student Education Faculty Support Data Collection Annual NRMP report Annual “ Medical School ” and “ Match ” articles in Family Medicine Role Models Admissions/ Pipeline Communications Education

Medical Student Education Student Interest FMIG Network FMIG Funding Initiative Web-Based Educational Forum Chapter Webinar on student interest National Conference Travel scholarships Virtual FMIG Target school activities Powerpoint templates (Your Future, PCMH) Informational and Educational articles targeted to students (AFP 2007, JMMS) AFP Clerkship Resource Advocacy for student debt/loan repayment activities New Student Interest Project

ACGME Competencies Medical Knowledge Patient Care Practice Based Learning and Improvement Systems-Based Practice Communication Professionalism

Our GME advocacy priority is and will continue to be that programs get payment for the residents they are training. Eliminate deductions such as volunteer preceptors, caps, limitation on training experiences, and use of unused slots. Resident Education

It’s a Great Day to be a Family Physician! “Difficulties mastered are opportunities won.” --Winston Churchill

Amy L. McGaha, MD, FAAFP Ashley DeVilbiss Bieck, MPA

National Workforce Planning: Federal government: Establish a national commission to address health workforce issues and establish a public- private entity to allocate funding for Graduate Medical Education (GME) positions in accordance with commission priorities. AAFP: Regularly assess and report on the family physician workforce. Summary Recommendations

Specialty distribution of the Physician Workforce: Develop a 10-year national plan with a workforce goal of 50 percent primary care specialties and at least 30 percent of ambulatory patient care provided by family physicians. Summary Recommendations

Funding/New Financial Models: Increase funding for Title VII. Designate preferential funding for medical schools that produce more primary care physicians. Increase payments to family physicians for clinical services. Develop, test, and implement new physician payment models. Require all payers of health care services to contribute to the costs of medical education. Summary Recommendations

Funding/New Financial Models: Designate two-thirds of GME funding for residency programs that support training in ambulatory settings. Develop collaborative rural training sites that will be priorities for support under expanded Title VII funding. Fund programs that train underrepresented minorities or those who practice in underserved communities. Establish GME funding streams that reflect population health needs in the United States. Summary Recommendations

Medical School Expansion: Target primary care rural and underserved practice. Increase PC loan repayment programs. Incentivize medical schools to address the public ’ s needs. Change medical school admissions policies. Dedicate a portion of the new medical school slots to family medicine or other primary care careers. Summary Recommendations

Delivery System: Develop and implement the patient-centered medical home (PCMH) model of care in all family medicine residency programs and in all primary care practice settings. Redesign family medicine residency training to ensure it addresses the evolving demography of the U.S. Summary Recommendations

Access: Community Health Centers as teaching and training sites for physicians. Expand opportunities (NHSC) for students to trade medical school debt for service. Improve physician payment for rural practice. Develop, test, and implement new compensation models for underserved practice locations. Foster NP and PA participation with primary care physicians in the team-based PCMH model. Summary Recommendations

Community Health Centers: --Increase National Health Service Corps opportunities. --Develop a Senior National Health Service Corps program. --Link graduate medical education funding to the development of “ Educational Health Centers ”. Summary Recommendations

Geriatrics: Encourage improved geriatrics training and care through Title VII funding. Develop, test, and implement new payment models for providing geriatric care. Summary Recommendations

International Medical Graduates: Avoid recruitment of physicians from countries with shortages of health care providers. (Melbourne Manifesto) Provide a specific number of training positions for exchange visitors. Summary Recommendations