Primary Care Retention

Robert C. Bowman, M.D.

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

• reductions of new graduates in family medicine and internal medicine

• losses of internal medicine, pediatrics, and medicine pediatrics to subspecialization

• losses of physician assistants and nurse practitioners away from primary care to other careers

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.

See also Health Care Access Primer  for definitions and discussion of what the nation needs for health access.

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