Q&A: Strong Match Day results for primary care viewed with ‘cautious optimism’

This year’s Main Residency Match saw a record-high number of positions offered in primary care, according to the National Resident Matching Program.

Of the 36,277 first-year positions offered, 50% were in family medicine, internal medicine (categorical), medicine — pediatrics, medicine — primary, pediatrics and pediatrics — primary. This marks a 2.7% increase from 2021, the National Resident Matching Program said. About 94% of the primary care positions offered in the Main Residency Match were filled.

Margot L. Savoy, MD, MPH, FAAFP, the senior vice president for education at the American Academy of Family Physicians, said that more family medicine physicians are needed to address the primary care workforce shortage in the U.S.

“When a student matches into family medicine, we get closer to this goal and closer to ensuring accessible, affordable, and equitable care for our patients and the country,” she said in an AAFP press release.

Healio asked Savoy, who is also a Healio Primary Care Peer Perspective Board member, to discuss how the Match Day results may impact the primary care shortage, efforts to expand the workforce in rural areas, and her advice for those who decide to pursue a career in family medicine amid the COVID-19 pandemic.

Healio: The AAMC predicted there would be a shortage of between 17,800 and 48,000 PCPs in 2034. Given the promising Match Day 2022 results, are we in a better position than we thought?

Savoy: Match Day doesn’t necessarily increase the number of physicians, but it increases potentially the number of people who are going to go into primary care. I look at this past Match Day with cautious optimism. We are matching too few family medicine doctors and people going into primary care specialties who are going to address that shortage. There’s a concern that as people retire, the shortage is going to get worse. COVID-19 accelerated that retirement, which is problematic.

On one hand, it’s exciting because I really thought we were going to have a disastrous couple of years. COVID interfered with students’ ability to spend time in clinical rotations, being around physicians and mentoring with people. Sometimes, that limits their perception of family medicine and primary care. I was worried it was going to be disastrous, but it wasn’t a disaster. I’m celebrating because we had a bit of a flattening, but it didn’t plummet.

On the other hand, for us to get where we need to go, we need exponential growth. I am in this cautious optimism space where I’m still concerned about it, but I’m optimistic that we will make a change in the future that will hit some of those targets.

Healio: Do you think the “ Fauci effect ” and visibility of physicians on the frontlines of the pandemic influence the Match Day results?

Savoy: Not so much the Fauci effect. We would need to see whether there’s more ID doctors, like how after ER was on TV, there were more people who wanted to become emergency room doctors.

The pandemic has allowed family physicians across the country to redemonstrate the value of having a strong primary care workforce. We were trained on a lot of things that people needed during the pandemic. People had to be flexible and agile — exactly what family physicians were trained to do. “Of course, I can cover the inpatient service, because I got trained to do inpatient when I was in residency. And, of course, I can help on OB, and I can help do the outpatient office.”

These are things that we learn about during family medicine training. Being embedded in the community made it easier for us to support patients through the pandemic. It was terrifying at the beginning, so figuring out what you needed to do and making sure that you had the right answers from people who you’ve already been working with was invaluable.

There are many students who never understood the reason why anybody would want to have a general background that you have in family medicine. The pandemic showed that we do need specialists, but there is a true value in having family medicine specialists who understand how to navigate the system and can move between parts of the system effectively. I hope that helps people to rethink some of their specialty choices.

Healio: How has the pandemic affected family medicine physicians?

Savoy: In some ways, it really energized them by getting a chance to step up and use their skills. To demonstrate the breadth and depth of your training is kind of exciting — you finally get to do some things that maybe you haven’t done in a while, or you get to learn something new.

For example, I’ve always thought telemedicine was an interesting thing that we should be considering in the office. To finally implement that was great. Did I want to do it during a pandemic? Not really. But it was great that we got to use our skills, resources, and talents.

On the other hand, it’s been stressful. Sometimes people forget that the folks on the frontline experienced frightening things early in the pandemic. That added to some moral injury where people felt like their health was being taken for granted. They felt like people were not taking the proper precautions to the things they needed to be safe. It was overwhelming the hospitals and making an already bad situation even worse. I think some of them had a different type of burnout feeling than what people were experiencing before the pandemic.

As things are opening back up, we’re starting to see another set of issues — things like financial pressures and strain. The same way inflation affects us at home, it seems like this is affecting practices, which now have increased costs. All the things that people needed to buy for COVID-19 protection, we needed to buy for our practices, too. All those wipes and cleaning products cost money. And so, we end up having to pay even more than we were paying before, when we already had a narrow margin.

Staffing shortages have also been difficult. These are things that added pressure. And so, on one hand, it was interesting and exciting to be able to use your knowledge and skills to be able to help your community. On the other hand, it’s heavy and hard work, and that does add burnout and stress. I describe it as moral injury because sometimes it feels a bit self-defeating. It feels like COVID is never going to end, and yet they still must come back to work the next day.

Healio: With burnout and stress at all-time highs, what advice do you have for incoming residents?

Savoy: My advice for residents is not unlike what my advice is for practicing physicians. It’s to strive for sustainability. You can’t always control everything about your career. You don’t necessarily get to control your exact schedule, the volume of patients or who’s going to get sick. In residency, you don’t get to choose to not be in training and not have the pressure of feeling like you need to learn everything right now. You must be okay with the fact that you’re going to feel some pressure and stress.

I think about some of the things that I did as a resident that were not very healthy. I didn’t always remember to go to the doctor. I didn’t follow up with the dentist. I didn’t get enough sleep. I didn’t eat right. These are things that I should have been practicing, even as a resident, so that I can have a sustainable life as a family physician. What I want for them is to start practicing healthy habits in residency, because those are skills that are just as important as your clinical acumen, your ability to diagnose a patient and your ability to be able to talk to a patient. If you’re not well, if you’re not healthy, you won’t be present for that patient. You’ve got to put that part into your training now.

Healio: Rural areas are particularly impacted by workforce shortages. What efforts are needed to incentivize incoming family medicine physicians to practice in these areas?

Savoy: Rural medicine is a serious challenge. We’re not aiming to have minimal coverage. We want people to be able to access all the same care they need, no matter where they live in the country.

When I think about how to address this, I think about the data that we’ve known for a long time. For example, we know that if you take people from a community and train them, they often want to come back to either that community or a similar one to practice medicine. The solution goes all the way back to middle school, where you have to get more people in rural spaces, or underserved spaces in general, to be curious, passionate and excited about STEM education and science classes.

That way, they have more people who are interested in medicine and someday will want to go back and take care of people where they feel most comfortable. That honestly is the biggest and most straightforward pathway to get more people in rural medicine. The same thing is true for inner cities or urban places. If you want more people who feel comfortable being able to work in a big city, you train more people in the big city to be interested in science.

When I listen to students and residents talk about what they’re looking for in medicine, it sounds very different than when I listened to the faculty who are above me on the generation spectrum. The folks above me talk a lot about loyalty and dedication — medicine is No. 1 in life and family is No. 2. They put everything into medicine. The younger generation is talking about medicine as a job: “While it’s important and I value it as a career, I have other aspirations and dreams. I don't want to be on call 24/7, and I don't want a job where I can never take off because there’s no other doctor in the whole region.”

And so, I think we’re going to have to get very creative when thinking about that solution. What happens when people — even if they want to come back to the rural space — don’t want to come back to the jobs that you’re offering them? You're going to have to find other ways for them to be able to connect with patients — potentially other ways for them to have access to care, maybe technology.

Perhaps this is where some things like telemedicine come into play, or maybe there’s an AI feature that helps us support some of these things. But we’re going to have to think that through because they’re not willing to give up their whole life to be the physician for the town, the way that maybe generations before them were willing to do. I’m guessing that’s part of where the shortage came from — they saw maybe how other people experienced it and just didn’t want to continue in that pattern.

We have to get creative and be thoughtful about that as a society, because I don’t think just paying people more money is the answer. And I don’t think it’s as simple as opening up a fancy space. I think those things matter, but I don’t think that’s really what’s driving it. There are a lot of lifestyle choices. So, it’s an affinity thing where you are where you’re from and want to take care of people who remind you of home, and then there’s this idea about lifestyle and balance and not having to sacrifice all that to be able to serve their community.

Healio: Do you have anything else to add?

Savoy: At the panel where students and residents were talking about what they were looking for in medicine, one of the students said something that struck me because it sounded profound coming from a student. The student said, “I don’t think you guys are recruiting the right people to go to medical school.” The way he explained it was that “when I look around and think about the metrics and who you recruit, you recruit for one type of person and then you expect them to magically become somebody different before the end of medical school. Maybe you need to rethink and reimagine how you’re interviewing and selecting people for medical school to get the outcome that you want, because if you consistently get all these people who want to go into places that are not what you need, then maybe you’re not picking the right people from the beginning.”

This begs an interesting question: How does society think about health care? If we know as a society that we need X number of primary care people and yet we don’t incentivize people to want to go into primary care because we do things like make them think their job is less academic or less prestigious, or we just choose to not pay them as well because we decide for whatever reason that specialists who do procedures are more important than specialists who think, then that really sets up a very strange dynamic where you’re literally incentivizing people to not do the thing that you know you need.

If our goal in life is to have a good quality of life and have people keep us well, then the answer isn’t pumping out more and more specialists. The answer is having more preventive people, and those preventive people are primary care people.

References:

Family medicine welcomes new residents in the Match program. https://www.aafp.org/news/media-center/releases/family-medicine-welcomes-new-residents-match-program.html. Published March 18, 2022. Accessed April 4, 2022.

NRMP delivers a strong match to thousands of residency applicants and programs. https://www.nrmp.org/about/news/2022/03/nrmp-delivers-a-strong-match-to-thousands-of-residency-applicants-and-programs/. Published March 18, 2022. Accessed April 4, 2022.