To educate a sufficient number of family physicians to meet the health care needs of the American public.

Strategic Directions:
1.1 Develop by 1995 a national needs assessment tool to determine the required number of family physicians, and therefore family medicine residency graduates. This tool should then be used by states to determine regional needs for family physicians.
 
Who:
AAFP Commission on Education, with liaisons from ABFP, AFPRD, ADFM, STFM, COGME, AMA.

Strategy:
Family Physician Workforce Reform: Recommendations of the American Academy of Family Physicians.

1. To achieve the desired ratio of 33.3 MD family physicians per 100,000 population in 2010, 3,870 MD family physicians will need to be produced annually in the U.S., an increase of approximately 900 over current annual production.
   
   
2. There should be up to 484 ACGME accredited family medicine residency programs by 7/1/2000, assuming an average of 8-9 PGY-I's, and 8-10 PGY-II's.
   
   
3. To achieve the desired ratio of 33.3 per 100,000 population by 2010, 3,870 general internists and pediatricians will need to be produced annually, an increase of approximately 400 over current annual production. This can be accomplished without additional residency positions if 65 percent of MD pediatric graduates and 45 percent of MD internal medicine graduates remain in generalist careers.
   
   
4. To achieve the projected increase of 25 percent DO generalists, approximately 600 DO's should train in family medicine residency programs each year. Based on historical experience, family medicine residency programs should anticipate that up to one-half may train in ACGME approved programs.
   
   
5. To achieve the projected increase of 50 percent in primary care NP/PA's, there should be 2.6 primary care nurse practitioners and physician assistants per 100,000 population by the year 2010 practicing in integrated practices under the supervision of primary care physicians.
   
   
6. The number of PGY-I positions available in the U.S. should be 110 percent of the total graduates of LCME and AOA accredited medical and osteopathic schools.
   
   
7. At 110 percent of annual MD and DO graduates, the number of PGY-I positions in the U.S. should be 17,240 if 55 percent of graduates are generalists, or up to 18,788, if 50 percent of graduates are generalists.
   
   
8. The number of MD graduates in the U.S. should be reduced by approximately 500, from 16,000 to 15,480, if 50 percent of MD graduates become generalists; or by approximately 1900, from 16,000 to 14,073, if 55 percent of MD graduates become generalists.
   
   
9. The number of DO graduates in the U.S. should remain at 1,600 annually.
   
   
10. Some medical schools will need to decrease enrollment or close. Specific medical schools which should be relatively protected from downsizing are those with a recent track record of producing generalist physicians, physicians located in and serving rural and inner city populations, and physicians from underrepresented minorities.
    
    
11. 1,567-1,708 PGY-I positions should be available annually for IMG's.
    
    
12. Federal funding for graduate medical education should reflect physician workforce policy, with preferential funding for training needed generalist physicians, and concomitantly less funding for the training of limited and sub-specialists in surplus.
    
    
13. The recommendations of the Seventh Report of the Council on Graduate Medical Education on financing medical education should be implemented.
    
    
14. All payors of health care services should contribute to the costs of medical education.
    
    
15. There should be established a public-private entity to allocate funding for residency positions among training programs.
    
    
16. Residency programs should be preferentially funded which have a track record of producing generalist physicians, physicians located in and/or serving rural and inner city populations, or physicians from underrepresented minorities.

1.2 Promote satisfactory completion of an accredited family medicine residency as the ideal training model for producing generalist physicians.

1.3 Encourage physicians in other specialties who have interest in and aptitude for generalist practice to complete a family practice residency by:

Increasing the size of family medicine residencies by an average of one to two second year positions beyond the number of first year training positions in programs.

Who:

Family practice residency programs, RAP, AFPRD, AAFP.

Strategy:

• Part of GME $ reform.
• Additional $ through Title VII over and above existing levels of appropriation.
• AAFP Hotline for R-IIs.