Selected Survey Findings Regarding Family Physicians from Gary Hart's WWAMI Report, now released
The HCs had 6,561 FTE physicians practicing in them (78% urban and 22% rural). Of all the physician FTEs, 47% were family physicians (FPs), 19% were general pediatricians, 22% were general internists, 8% were obstetrician/gynecologists, 3% were psychiatrists, and only 1% were other types of specialists.
By way of comparison, there were 3,429 registered nurse (RN), 2,103 nurse practitioner (NP), 1,095 physician assistant (PA), 1,125 dentist, and 439 pharmacist FTEs.
Key findings include the following:
FPs comprised 61% of all rural HC physicians and 43% of all urban physicians.
While the overall national HC vacancy rate for FPs was 13.3%, the FP vacancy rates for rural areas increase with their degree of rurality—12.6% in large rural town, 19.2% in small rural town, and 18.5% in isolated small town areas (see graph). The overall HC vacancy rate for RNs was 10.4%.
There were 426 current vacancies for which FPs were being recruited (compared to 102 general pediatrician, 115 general internist, 116 obstetrician/gynecologist, 47 psychiatrist, 379 RN, 195 NP, 80 PA, and 310 dentist FTE vacancies).
28.4% of the FP vacancies had been vacant for longer than six months at the time of the survey.
WWAMI Rural Health Research Center contact wwamirhrc@fammed.washington.edu for more info or Telephone 206-685-0402
The Good News – FPs are doing all that we have asked them to do, rural, urban poverty, mental, women’s health, poor, less educated, etc.
The Good News – Government continues to fund 330 Community Health Centers and promises access to all
The Bad News – no provision for supplying those who form the major component of such centers
The Bad News – still no solid provisions for collaborative work or support of residency training by CHCs, even those that we have supplied with FPs politely decline to support the hundreds of thousands in support we send them yearly
Summary of Family Medicine Graduate Contributions From Gary's report, from FP sources and from the Masterfile data
There are 3200 office based FP graduates a year (AMA Masterfile 2005 locations for 1987 – 2000 graduates)
400 - 730 FPs per year doing poverty locations of all types rural or urban (practice zip code pop in poverty at 20% or above)
200 FPs a year going into CHCs, about 6% - estimate from Hart
120 - 160 a year doing rural poverty, especially native females, rural born whites
300 - 500 a year doing urban poverty, especially females, black, Mexican American
200 FPs per year doing military, about 6%
may be decreasing now but currently 40 - 60% of the physicians at military zip codes
400 to 800 FPs per year doing rural, 800 was peak in 1995,96,97 graduates, down to 500 or less a year now about 18 - 25%
45% increase in rural FP choice for these years compared to early 1990s
100 – 200 a year doing teaching - 3 - 6%
Conflicting Needs
Unfortunately the military, CHC, IHS, teaching, and rural all tend to involve the same types of distributional FP residents (older, rural born, inner city born, lower income origins), which are admitted in the lowest levels in the nation to medical school, rates 50% to 600% lower than the average student. Admissions Ratios and US Medical Students
The first of the reasons would have to be education, expectations, and education funding and distribution, which are major problem areas for the nation and getting worse with the most impact on FP and those doing underserved practices since the origins are underserved and losing out the most.
Average for US is 1 out of 200 who are medical school age are in allopathic medical schools. Average for Asian Indian is 1 in 20 (best ratio). Average for Native is 1 in 280, average for all rural born 1 in 360. Average for Black students is 1 in 300 for females and 1 in 600 for males, rural plus lower income 1 in 750, Mexican American male 1 in 1000 and female 1 in 1300 - Combinations of poor and rural and minority or chronic poverty minority urban born approach zero probability of admission.
Rich and educated and urban = admission, 99% pass rate for medical school but 2 - 5% choice of FP
Lower income, rural born, older = 30 - 50% less chance of admission, 3 - 9% failure rate, but 50 - 100% greater choice of FP, rural, or urban poverty primary care.
Changes in admission
Income - Each year 500 - 700 more students admitted whose parents made more than $100,000 (out of 16000 matriculants). This excludes rural and lower income types. This translates to fewer choosing FP, primary care, primary care poverty, and rural practice each year. The correlation between % admitted who are rural born and % choice of rural practice is 0.86 to 0.92 depending on type of rural definition. Schools admitting more rural born also admit more older, more instate born, more born in lower income counties, and have lower MCAT score averages for the school. (not including atypical and osteopathic schools in MCAT considerations)
Rural born - decreasing steadily from 27% in 1940s to 10% of graduates now.
Foreign born and Asian - foreign born increasing from a few % to 16%, Asian total to 22% or 3500 of 16000 - increasing Asian admissions squeezes out the urban born that share schools and cities as well as the lower income and rural types at the bottom of the socioeconomic scale. There is not a problem with Asian or Foreign born, the problem lies in US schools, education, and families that are not doing what should be done in education.
Ethnicity Gender and Rural Practice Choice
White male rural born FPs the most likely to do rural practice and poverty rural practice but also the most likely to do military.
Admissions of whites, males, instate born, and rural born are declining the most rapidly and have been for 20 years - all are factors in choice of family medicine, choice of rural practice, and retention in the same state as the medical school.
Black or Mexican American FP females - the most likely to do urban poverty but also the most likely to do academic FP and academic FP always gets the most contact and opportunity
Private allopathic and private osteopathic grads (high tuition levels) choose military FP at the highest levels - second only to those born in military bases in choice of military family medicine, some only months before they could have started serving the underserved. Military Family Physicians
Our policies as a nation regarding the underserved are bankrupt in all phases of health policy, education, and medical education.
Only 10 years ago we had the best distribution in the nation's history. A summary of birth origin and other works related to physician distribution at Physician Distribution in the United States
Robert C. Bowman, M.D. rbowman@unmc.edu