Decentralizing Graduate Medical Education Could Resolve Maldistribution of Physicians

FOR IMMEDIATE RELEASE: Friday, November 15, 2013 

Contact: 
Leslie Champlin 
Senior Public Relations Strategist 
American Academy of Family Physicians 
(800) 274-2237, Ext. 5224 
lchampli@aafp.org 

WASHINGTON — The United States could significantly reduce the maldistribution of physicians by changing the dissemination of graduate medical education funding, according to research in the Nov. 15 issue of American Family Physician. 

The research, presented in a one-pager, "Migration After Family Medicine Residency: 56% of Graduates Practice Within 100 Miles of Training," by E. Blake Fagan, MD, and his colleagues, reviewed data from the American Medical Association Physician Masterfile to determine where newly minted physicians practiced after completing residency training. In addition to identifying 56 percent of residents who practiced within 100 miles of their residency training, they found that nearly 40 percent located within 25 miles of their training site and nearly 20 percent located within five miles. 

"Where family medicine residents train has a big impact on where these new physicians will practice," said Fagan. "If the nation’s workforce policy is to increase the number of primary care physicians in rural areas, then we need to increase funding to our rural family medicine training sites and establish new residency programs in those areas because the majority of graduates practice close to where they train." 

Maldistribution of physicians has consistently plagued underserved Americans' access to care. The problem, Fagan writes, is compounded "by the limited volume of training outside of major metropolitan areas and large academic health centers." 

Numerous studies have demonstrated the success of rural training tracks in graduating primary care physicians who practice in underserved areas. Most recently, research by Robert Phillips, MD, MSPH, and his co-authors reported that up to half of medical residents who trained in rural health clinics, critical access hospitals and federal qualified health centers — which serve most of the nation’s uninsured and underinsured patients — returned to practice in those settings after completing residency training. 

Other research on rural training tracks demonstrate that they almost double the percentage of primary care graduates and increase rural physicians almost sixfold. 

"These findings seem to support current efforts to decentralize graduate medical education training through models such as teaching health centers and rural training tracks," Fagan and his colleagues conclude.