Editor's note: Ronald Fong, MD, MPH is the director of the Family Medicine Residency Network in the Department of Family and Community Medicine at UC Davis.

Posted on 04.13.10 by Ronald Fong, MD

In their third year of medical school, students transition from the basic sciences to their clinical rotations.  These formative weeks shape the future physician workforce.  From 1997 to 2009, the number of family medicine residency positions offered in the United States has decreased from 3,362 to 2,555; filled positions have declined from 2,905 to 2,329.  Moreover, the percentage of US graduates filing positions in that span has plummeted from 71.7 percent to 42.4 percent.

During their clinical rotations, medical students evaluate a discipline's scope of practice and employment opportunities.  As a family medicine faculty member, I wonder how much our student interactions have contributed to the falling interest in family medicine.  Our scope of practice spans from delivering babies to obtaining a Certificate of Added Qualifications in Geriatrics for the betterment of our senior patients.  Family physicians practice in the widest settings: remote rural regions, inner-city underserved populations, international refugee camps.  Specialists are usually concentrated in urban metropolitan areas due to their intertwined function with tertiary centers.  Somehow, our attributes are insufficient to draw a greater number of students into family medicine.

Perhaps, family physicians need to go beyond modeling our vocation and emerge as advocates for our convictions.  We stand in quiet support when welcoming the entrance of a child into the world and at upholding the dignity of a patriarch's remaining moments on earth.  Our voices rage against health disparities.  But we remain all too silent about sharing our value to our patients and our communities.

We need to reach out and to stand behind those who already support family medicine.  Every day we encounter and interact with patients who have placed their trust in our discipline.  We should acknowledge their faith and thank them for supporting family medicine.

We need to remember our roots and lineage of family medicine.  The house call was our calling cared.  Although family medicine has been designated a board-certified specialty since 1969, our core values are as timeless as compassion and stewardship.  We are the force that elevates neighbors into friends; bonds friends into families; unites families into communities.

Finally, we need to redeem ourselves.  According to data from the Bureau of Labor Statistics, there were 633,000 employed physicians and surgeons in the US in 2006.  Family physicians and general practitioners comprised 12.3 percent (77,859) of the workforce.  In comparison, anesthesiologists comprised 5.2 percent (32,916).  The Center for Response Politics reported that the American Society of Anesthesiologists (ASA) contributed $1,074,850 to federal candidates during the 2006 election cycle.  In the same cycle, the American Academy of Family Physicians was not in the top 20 in health professional organizations contributions.  The American Association of Clinic Urologists was No. 20 on the list and contributed $336,167.  In 2008, the ASA contributed $1,466,400.  The AAFP was ranked No. 18 with $691,943 in contributions.

We have to reclaim our value and place among specialties and that redemptive process will need to involve enhanced political banding and mobilization.  Furthermore, this is an aspect of our heritage that must be bestowed to our interns.  Some will argue that the anesthesiologists can contribute more because they have higher compensations.  The medial salary for family medicine in 1997 was $136,000.  For anesthesiology, it was $244,000.  Twelve years later, the medial salary for family physicians is $198,000 without obstetrical practice, and $202,000 with.  For anesthesiology, it was $367,000.

Until we take a stand to break this cycle and increase contributions to their political action committees, the compensation gap between family physicians and other specialists will persist.  And, this gap does have an impact on the physician workforce composition.  From 1997 to 2009, the number of anesthesiology residency positions offered more than double (from 317 to 733); filled positions leaped form 197 to 723.  Correspondingly, the percentage of US grads filling those positions during that time increased from 25.2 percent to 83.5 percent.

Unlike Mark Anthony, I come to praise anesthesiologists, not bury them.  I cheer, not chastise, our anesthesiology colleagues for providing us with a clear blueprint on how to advocate efficiently and effectively.  The numbers are clear, so is our mission.  Now, are we as committed to this mission as we are to our patients?  Do we understand that this mission serves our patients and the future of our discipline?