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The number of primary care physicians in the USA continues to decline as the number needed rises. In 2008, office visits to primary care physicians in the USA were estimated to be 462 million, which is greater than 50% of all office visits Americans made; this number is projected to increase 22% to 565 million visits in 2025.1 According to the US Agency for Healthcare Research and Quality, there were approximately 209 000 practising primary care physicians in 2010, representing less than one-third of all US physicians involved in direct patient care.2 Additionally, national health care reform via President Obama's 2010 Patient Protection and Affordable Care Act is expected to expand insurance coverage to over 30 million Americans, leading to an anticipated shortage of more than 65 000 primary care physicians by 2025.3 Newly trained physicians are demonstrating a preference to specialise over choosing primary care careers. Clearly, in order to address the primary care workforce shortage, the US medical education system must make changes.
Too few US medical students are choosing to become primary care physicians—which includes family physicians, general internists and general paediatricians. Residency fill rates by US graduates into family medicine fell from 73% to 44% between 1996 and 2008.4 Meanwhile, the number of internal medicine and paediatrics residents practising primary care has dropped sharply. Subspecialisation rates jumped from 52% to 62% for internal medicine, and from 27% to 42% for paediatrics between 1995 and 2005.4 In 2009–2011, only 22% of internal medicine residents planned to pursue primary care careers.5 As of 2012, there has been a small increase in the number of medical students choosing to train in primary care, but there continues to be a greater preference for subspecialties.6
For medical students contemplating primary care, significantly lower income levels compared …
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