Why Are There Never Enough Family Physicians to Provide Care for the People of the United States?

The US environment for healthcare and healthcare research is not conducive to providing adequate family physicians to care for the needs of the US population. Medical student interest in family medicine is discouraged by many factors, including the culture of medical schools; physician-payment realities, including the American Medical Association's (AMA) Current Procedural Terminology (CPT) codes; the rules by which Centers for Medicare and Medicaid Services (CMS) determines physician and hospital payments; a lack of family medicine research funding; and a favoritism of resources devoted to hospitals and partialists (specialists). Family medicine is also negatively impacted by the generally poor understanding of its value among US policy makers and health-system observers. Family physicians contribute to better population health at a lower total cost. But many policy makers and observers have internalized inaccurate assumptions and misunderstandings of: (a) the role of wellness and lifestyle education, (b) the limits of the triple aim and common preventive services and single-disease metrics, (c) the results of 50 years of cost-effectiveness research, (d) inattention to referral rates, (e) inadequate recognition of family physicians' knowledge and ability to work within complex healthcare systems for the benefit of their patients, and (f) an over-reliance on population management. The full potential of family medicine to make its most effective contributions will only emerge when these issues are addressed.