Four Pillars for Primary Care Physician Workforce



Despite the changing health care environment’s increasing need for primary care physicians that can manage populations, deliver care in interdisciplinary teams and address quality outcomes, national data indicate that not enough students and residents are choosing careers in primary care. According to family medicine organizations and researchers, “factors that influence specialty choice [include] individual learner characteristics, training and practice environments, and payment systems. The Annals of Family Medicine featured a paper titled The Four Pillars for Primary Care Physician Workforce Reform: A Blueprint for Future Activity that offers a framework with consistent language to guide efforts to increase the number of well-trained primary care physicians available to provide care. The foundation on which the four pillars stand is the Institute of Medicine’s definition of primary care which is:

“Primary care is the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community.”

The four pillars are as follows:

  1. Pipeline – the continuum of identifying, recruiting, and sustaining those students who are most likely to seek careers as primary care physicians
  2. Process of Medical Education – the traditional focus on curriculum development throughout medical student and residency education
  3. Practice Transformation – the transition to the Patient-Centered Medical Home
  4. Payment Reform – increases in primary care physician income with attention to funding for medical education

The first two pillars pertain mostly to all those under pressure to increase numbers of primary care graduates (e.g., medical school deans, admissions directors, curriculum committees). Insurance companies and larger health systems must address the third pillar. Finally, the fourth pillar, and most difficult one to achieve, must be addressed by state and federal legislators, insurers, health systems, professional organizations and the public.

The Council of Academic Family Medicine, which represents the family medicine academic organizations, has adopted the four pillars as their model to determine conditions that are conducive to increasing the number of primary care physicians. Other family medicine organizations including the American Academy of Family Physicians (AAFP), the American Board of Family Medicine, and the AAFP Foundation have also embraced this model as a strategy for growing the number of primary care physicians

Ultimately, this four-pillar framework is expected to provide family medicine organizations and other stakeholders with “consistent messaging for advocacy for appropriate primary care workforce development programs.” It can also serve as a frame work for medical associations and accreditation bodies, and it will be useful to the larger primary care community as it strives to provide quality health care for Americans.


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