Pathways To Primary Care: Charting Trajectories From Medical School Graduation Through Specialty Training.

Area of Science:

• Health Policy
• Medical Education
• Physician Workforce Studies

Background:

• US healthcare faces primary care physician shortages impacting access, quality, and equity.
• Disinformation regarding physician training pathways complicates policy solutions.

Purpose of the Study:

• To analyze physician training trajectories from medical school through postgraduate training into primary care specialties.
• To quantify the primary care yield for different specialties and physician types.

Main Methods:

• Retrospective cohort study utilizing American Medical Association Physician Masterfile and Historical Residency File data.
• Analysis of physician training pathways for doctors of medicine, doctors of osteopathic medicine, and international medical graduates (2001-2015).
• Sankey diagrams used to visualize training program flows.

Main Results:

• Of 353,590 physicians graduating 2001-2015, initial training included 11.8% in family medicine, 33.5% in internal medicine, and 10.5% in pediatrics.
• Primary care yield was 97.0% for family medicine, 35.5% for internal medicine, and 54.4% for pediatrics.
• Significant percentages of physicians left primary care after internal medicine and pediatrics residencies for subspecialty training.

Conclusions:

• Family medicine demonstrates a high retention rate within primary care post-residency.
• Internal medicine and pediatrics see substantial attrition from primary care into subspecialties.
• Further research is needed to track physicians entering primary care practice careers.