Primary Care Retention

Robert C. Bowman, M.D.

The United States is losing primary care steadily over time. This includes

Family physicians remain 99% active, 98% in family medicine, 90% in office primary care, and concentrate away from Major Medical Centers. Declines in family medicine choice are a major problem for primary care access. This decline and losses of NPs and PAs and declines in generalist internal medicine choice are a likely result of failed health policy. Readers are recommended to compare Changes in Specialty Choice 1987 - 1999, the primary care retention data below, Managed Care Comparison Tables, the comparisons of the FP match in the Distributional Medical Schools graphic, and the tables in Managed Care and Choice of FP.

The NRMP Match is not intended to be used for calculations of primary care workforce although it has often been used in predictions. Primary care workforce levels are poorly predicted by the NRMP Match, with perhaps the exception of family medicine. Even in FP the match levels are actually low since residents are added in subsequent years as new first and second year family physicians. Generalist pediatric levels have a slight decline over time, suggesting career choices that were made early in medical school or before. All other primary care careers represent maximum values at the match or soon after with a deterioration with time distance from medical school graduation. Medicine pediatrics losses are the most significant. Office-based levels, a reasonable reflection of generalist primary care, also tend to deteriorate over time in all primary care specialties as physicians choose teaching, research, administration, inactivity, or hospital forms of care. Primary care retention is an important concept that has rarely been considered.

Primary Care Career Changes 1987 - 1999 US MD Grads as of 2005 Masterfile Careers

  1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999  
Medicine Pediatrics                            
     Office Based 9 8 16 18 29 61 115 175 235 233 264 257 169  
     All Listed in Masterfile 14 11 22 20 38 67 132 189 248 249 290 292 255  

     % in Office MPD

 64% 73% 73% 90% 76% 91% 87% 93% 95% 94% 91% 88% 66%  

     US Seniors in NRMP

 151 143 137 149 161 166 194 237 313 336 387 374 347  

     % Office / Match

 9% 8% 16% 13% 24% 40% 68% 80% 79% 74% 75% 78% 73%  
  Steady losses over time with loss to subspecialties            

Internal Medicine

                            
     Office Based 1599 1550 1422 1390 1532 1680 1808 1733 1887 1831 1748 1625 1410 21215
     All Listed in Masterfile 3628 3679 3498 3373 3231 3398 3382 3566 3836 3875 3953 4016 3835 47270
     % in Office IM 44% 42% 41% 41% 47% 49% 53% 49% 49% 47% 44% 40% 37% 45%
     IM, Prelim, Primary 4450 4703 4603 4416 4295 4258 4030 4086 4072 3984 4052 4249 4266 55464
     % in Office IM 36% 33% 31% 31% 36% 39% 45% 42% 46% 46% 43% 38% 33% 38%
     IM Plus Primary Only 3419 3525 3291 3047 2897 2913 2705 2848 3009 3083 3206 3306 3209 40458
      % Office / Match 47% 44% 43% 46% 53% 58% 67% 61% 63% 59% 55% 49% 44% 52%
  declines recovery with policy steady declines with more to come  
Pediatrics                            
     Office Based 943 869 841 889 966 940 1073 1066 1176 1285 1291 1240 1211 13790
     All Listed in Masterfile 1380 1324 1288 1331 1419 1431 1584 1690 1864 1992 2069 2141 2073 21586
     % in Office Peds 68% 66% 65% 67% 68% 66% 68% 63% 63% 65% 62% 58% 58% 64%

     US Seniors in NRMP

 1332 1289 1256 1265 1296 1309 1361 1404 1480 1548 1596 1702 1742 18580

      % Office / Match

 71% 67% 67% 70% 75% 72% 79% 76% 79% 83% 81% 73% 70% 74%
  fairly stable over time after graduation                  
Family Medicine                            
     Office Based 1618 1452 1461 1468 1461 1519 1755 1954 2155 2368 2391 2190 1939 23731
     All Listed in Masterfile 1847 1633 1633 1662 1667 1778 2010 2285 2484 2622 2636 2459 2201 26917
     % in Office FP 88% 89% 89% 88% 88% 85% 87% 86% 87% 90% 91% 89% 88% 88%
     US Seniors in NRMP 1729 1493 1468 1418 1374 1398 1636 1850 2081 2276 2340 2179 2024 23266
      % Office / Match 94% 97% 100% 104% 106% 109% 107% 106% 104% 104% 102% 101% 96% 102%
        Additions after the Match