The Match and Primary Care

Chitose Suzuki/Associated Press

BUSM students find out where they are accepted for residency on Match Day 2009.
This photo was featured in the New York Times.

Each year, on March 19, thousands of medical school seniors receive their long-awaited match results indicating which residency they will attend. So how did Family Medicine fare this year?

At BUSM, Family Medicine matches held relatively steady, while nation-wide numbers were down. 9 students matched in family medicine this year (down from 10 last year). Match sites included:

• Boston University
• Swedish First Hill, Seattle
• Swedish Cherry Hill, Seattle
• Middlesex, CT
• UCSD, CA
• Contra Costa, CA
• Brown University, CA
  

According to the Boston Globe, primary care match rates are holding fairly steady across the state.:

• BU: 26 percent of 150 students (17 percent last year)
• Harvard: 10 percent of 165 students (12 percent last year)
• Tufts: 18 percent percent of 104 students (17 percent last year)
• UMass: 39 percent of 100 students (35 percent last year)

However, nation-wide reports that only 1,083 graduating US medical seniors chose family medicine this year, 89 fewer than last year. However, 2,329 of 2,555 family medicine residency positions were taken for a fill rate of more than 91%, which is slightly greater than last year. The difference between family medicine residency positions taken and matching US seniors is filled by foreign international graduates, who fill more than half of all available family medicine residency positions.

Why do more medical students not choose family medicine? A recent report from the Graham Center showed that more medical students would choose careers in primary care if schools were to (1) increase student recruitment from rural and medically-underserved areas and (2) provide long-term experiences in primary care.

Do you agree? What do you think should be done to increase the number of students entering family medicine?

References

• "Primary Care Gains on Match Day" Boston Globe, March 19th, 2009
  
• "A Medical Student's Rite of Passage" New York Times, March 19th, 2009
• "Fewer Medical Students Choose Family Medicine in 2009 Match" AAFP News Now, March 19th, 2009
• "Advance Data Tables: 2009 Main Residency Match" NRMP
  

From the Front-Line to the Front-Row: President Obama and Family Medicine

AAFP President Ted Epperly, MD speaks to President Obama at the
White House Health Care Summit on March 5th, 2009. Watch the YouTube video.

As the White House Office of Health Reform, headed by Nancy-Ann DeParle, takes on the urgent task of designing a health care system that works for everyone in the United States, Family Physicians are playing a key role in this debate. At the White House Health Care Summit on March 5th, 2009, President Obama's administration invited about 120 key stakeholders to the White House to build bipartisan support for the work being done. The AAFP, represented by AAFP President Ted Epperly, MD (Boise, Idaho) was one of seven medical associations present.

Of the seven organizations - which included the American Medical Association (AMA), the the third-largest lobbying group (based on expenditures) - President Obama called on the AAFP to represent the perspective of primary care physicians. A surprised Epperly stated that family physicians are ready to "roll up their sleeves" to support the changes needed to improve health in the United States. He also noted the critical need to address physician workforce shortages.

This opportunity resulted in the creation of the AAFP "Connect for Reform" campaign to bring together physicians working on the front-line of health care reform and to take their issues to the front-row of the debate on health care reform. With the President's ear already open to the voices from the front-line, this is a unique opportunity to make the changes that you think will fundamentally improve our health care system.

Connect for Reform Now!

References

• "It's a New Day for Health Reform in Washington and You Should Be Involved" AAFP, From the President, March 13, 2009
• AAFP President Tells Obama of Need To Strengthen the Nation's Primary Care Workforce, AAFP News Now, March 6th, 2009

Mental Health In Primary Care

On March 19, Dr. Larry Culpepper, Chair of the Family Medicine Department, and Dr. Doug Hughes, Clerkship Director for Psychiatry, led a very informative lunch-time discussion on the role of the primary care physician in mental health care, as well as the importance of collaboration between psychiatrists and PCPs. Dr. Culpepper spoke about research demonstrating the importance of treating depression in improving health outcomes for patients with diabetes and heart disease. In addition, Dr. Hughes highlighted the necessity of teamwork between psychiatrists and PCPs to minimize harmful drug interactions as well as to monitor the adverse systemic side effects of some psychiatric drugs and conversely the adverse psychiatric outcomes related to systemic treatments. Overall, Dr. Culpepper and Dr. Hughes highlighted the need for clinicians to be aware of mental illness and its impact on patient functioning, as well as the need for insurance companies to ensure parity for both mental health and systemic diseases.

Dermatology Workshop

The Residency Program from Central Maine Family Medical Center came to present their residency program, and teach us a few common dermatological procedures seen in family medicine practices.

We used pig's feet to practice making elliptical excisions of "moles" and then were taught how to suture them up. The second exercise of the workshop was taking punch biopsies from the pig's feet, and suturing the cut shut. The Maine team also taught us how to use the liquid nitrogen as a treatment for warts and superficial lesions, as well as a scraper for shaving off surface growths (again, practiced on pig's feet). The basics of skin cancer were also reviewed.