Less than 25% of medical school graduates go into primary care, and far fewer go into areas with health provider shortages despite federal spending to promote rural health care, a study found.
Researchers looked at data from federal agencies and the American Medical Association's Physician Masterfile to measure graduates from 2006 to 2008 who entered medical practice in high-need specialties and underserved areas from their Graduate Medical Education program.
Results appeared in Academic Medicine.
Among 759 sponsoring institutions, the weighted, mean percentage of graduates in primary care was 24.2%, with a median of 17.7%. Among the programs, 158 institutions produced no primary care graduates, and 184 institutions (mostly smaller ones) produced more than 80%. For those programs that provided internal medicine training, retention in general internal medicine ranged from 8.3% to 95.2%, with an average of 37.9%.
Overall, 198 institutions produced no rural physicians, 10 institutions had all graduates go to rural areas (weighted mean for all programs was 8.5% rural; median 6.3%). The average percentage of graduates providing direct patient care in rural areas was 4.8%. There were 283 institutions that produced no physicians practicing in federally qualified health centers (FQHC) or rural health centers (RHC) and 479 institutions that produced no physicians in the National Health Service Corps (NHSC).
Researchers noted, "Primary care physician production of 25.2% and rural physician production of 4.8% will not sustain the current workforce, solve problems of maldistribution, or address acknowledged shortages. The relatively small number of physicians choosing to work in RHCs, FQHCs, HPSAs, and the NHSC will not support a doubling of the capacity of safety net services envisioned by the Affordable Care Act."