Intended for healthcare professionals


US production of new primary care doctors falls far short of need, study finds

BMJ 2013; 346 doi: (Published 20 June 2013) Cite this as: BMJ 2013;346:f4018
  1. Michael McCarthy
  1. 1Seattle

Despite the growing need in the United States for primary care physicians, less than 25% of doctors coming out of US training programs are going into primary care, a study has found.

The findings show a serious mismatch between the kinds of doctor the US needs and what is produced by its taxpayer funded graduate medical education system, said the study’s lead author, Candice Chen, assistant research professor of health policy at George Washington University’s School of Public Health and Health Services in Washington, DC.

Currently only about 30% of US physicians practice primary care, far less than the 40% target recommended by the Counsel on Graduate Medical Education, which advises the Department of Health and Human Services on physician workforce issues.

“If you consider that right now we’re at 30%, that the minimum we should be aiming at is 40%, and yet we’re actually producing less than 25%, you can see we have a problem,” Chen said.

In the study, published online in Academic Medicine, Chen and colleagues identified 8977 physicians who completed their residency training in the US between 2006 and 2008. They then determined what specialty the physicians practiced 3-4 years after graduation and where they practiced.1

Only 25.2% of the physicians worked as primary care doctors, and only 4.8% practiced in rural communities, Chen said, adding that even the 25.2% figure was probably an overestimate because it included graduates who practiced as hospitalists.

Of the 759 US graduate medical training programs studied, 158 produced no primary care physicians, 198 produced no physicians who practiced in rural areas, and 283 produced no doctors who practiced in federally qualified health centers, clinics that serve low income patients in urban and remote rural communities. Programs that produced a larger proportions of primary care physicians tended to be smaller ones located in smaller communities, Chen said.

It is estimated that more than 66 million people in the US live in rural or urban communities lacking in adequate primary care services.

Chen said that although the federal government spent more than $13bn (£8.4bn; €9.9bn) a year to fund graduate medical education, it placed few requirements on the kind of clinicians the programs produced.

“We hope with this study we’ve made a tool that policy makers can use to track what graduate medical education programs are actually producing and create a system that is more aligned with our needs,” said Chen. “We’re putting all this money into graduate medical education, yet we’re not getting what we need out on the other side.”


Cite this as: BMJ 2013;346:f4018


View Abstract