Inside the AAFP's New Effort to Boost Primary Care Training
Medscape Medical News spoke with Karen B. Mitchell, MD, vice president of Student & Resident Initiatives at the American Academy of Family Physicians (AAFP), about the effort. This interview has been edited for length and clarity.
Karen B. Mitchell, MD
Medscape Medical News: Some of these challenges have been apparent for many years. What problems are this new initiative attempting to address, and why is it imperative now?
Mitchell: The challenge we're facing is that it's harder for applicants to go find the program that they really want. So, we are aiming to have applicants find programs that are the right programs for them, while having programs also be able to find those applicants who are really interested in them. In family medicine, because of the high number of residency programs, that has become even more challenging for applicants to find us. We want to reduce the barriers that applicants may be facing.
We have the highest number of residency programs — over 800 — which also means increased challenges for the applicants to find the residency programs. Most programs have about seven slots, but some have as few as four. That is why we're looking at this now.
Medscape Medical News: What has been the trend in the number of medical students looking to enter primary care? The shortage of primary care physicians would lead us to think the numbers are down. Is that the case for family medicine?
Mitchell: It's not so much a decline. We were down this year in the main Match by 21 people — which when you're talking about 5000 matches, that's pretty stable. Meanwhile, the number of available positions in family medicine has grown. And that growth is happening in the locations we need for the future training of our primary care workforce.
Medscape Medical News: The initiative stresses the importance of 'geographical distribution' of trainees in family medicine. Can you tell us a bit more about this goal — is it really a synonym for 'rural' or is the term more expansive?
Mitchell: It is rural and more, in that what we aim for in family medicine is to be serving the communities across the country. We also know that our family medicine residents tend to stay in the areas and the settings where they do their training. And so, it becomes very important that family medicine residencies are designed to be based in the communities where we need the future workforce to be. So yes, it is rural, but we still would say there's community settings even in urban areas, where we also need more primary care physicians.
Medscape Medical News: What is your approach to diversity, equity, and inclusion issues now? Are you finding fewer diverse students going into family medicine?
Mitchell: We know that a diverse physician workforce that reflects the population results in better health outcomes. We are concerned about legislation that bans any race-based mandates in medical schools and accreditations, and anything that's cutting off federal funding in medical schools could have a detrimental effect on training. So, we are quite concerned about that and we are committed to protecting these programs because they are essential in correcting historical underrepresentation in medicine and important to improve health outcomes in underserved communities.
Medscape Medical News: Some students go into medical school thinking they really do want to become a primary care physician or a family physician, and then somewhere along the way they change their mind. So, is the issue attracting people to begin with or keeping them on the track?
Mitchell: It's both. Data from the Association of American Medical Colleges tell us that around 4% or 5% of medical students entering medical school say they want to do family medicine. Those matching into family medicine in the first round of the Match represent about 11% of the total US seniors and graduates, with about 8% coming from US medical schools specifically. By the end of Match week, family medicine fills about 13% of all residency positions available. The fact that we get a much higher percentage out of that by the time they graduate says we are gaining students along the way.
What we also know from our data about factors that influence the students' choice about family medicine is that creating deep and early relationships makes a difference. Having mentorship and then having positive family medicine experiences, especially in their third year, their clerkship year, those are all things that make a difference in choosing family medicine. And the AAFP is committed to strengthening all of those factors.
Part of the reason we're taking this broader look at the whole process is to be able to identify the bright spots where things are working. But we also recognize that, if you've seen one family medicine program, you've seen one family medicine program. They are so different, and that means what works really well for one program may not translate to work for other programs. We want to be able to identify where there may be an approach that really helped some programs that may be applicable to others.
Medscape Medical News: How might the Trump administration's efforts to cut loan forgiveness programs affect family physicians in particular?
Mitchell: The Public Service Loan Forgiveness [PSLF] program has been very important to our primary care physicians. We know AAFP members have enrolled in these student loan repayment programs and specifically in PSLF; 86% of our primary care workforce is enrolled in those kinds of programs.
We very much support that kind of loan repayment. It becomes very important as an incentive to pursue primary care. AAFP also supports some of the other loan repayment programs, such as the National Health Service Corps, which are very important for addressing some of the issues with physicians choosing to practice in primary care.
We also support the Resident Education Deferred Interest Act that was reintroduced earlier this year and allows medical students to defer their student loan interest during residency.
Medscape Medical News: What's the timeline like for this effort?
Mitchell: We are in the process of putting together a group of stakeholders from residency programs, including program directors and coordinators, advisors from medical schools, and learners themselves. We plan to have an in-person convening to bring together the ideas, and that's scheduled for this fall. What we're aiming for is that by the time we hit next year's Match day, in March of 2026, we have a good sense of where we're going for family medicine because we also know that any changes that we plan to implement will take at least another 1-2 years.
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