This is the 18th report prepared by the American Academy of Family Physicians (AAFP) on the percentage of each US medical school’s graduates entering family practice residency programs. Approximately 15.4% of the 16,114 graduates of US medical schools between July 1997 and June 1998 were first-year family practice residents in October 1998, compared with 16.6% in 1997 and 15.9% in 1996. Medical school graduates from publicly funded medical schools were almost twice as likely to be first-year family practice residents in October 1998 than were residents from privately funded schools, 18.8% compared with 10.7%. The Mountain region reported the highest percentage of medical school graduates who were first-year residents in family practice programs in October 1998 at 22.0%; the Middle Atlantic and New England regions reported the lowest percentages at 9.9% and 8.7%, respectively. Half of the medical school graduates (50.0%) entering a family practice residency program as first-year residents in October 1998 entered a program in the same state where they graduated from medical school. The percentages for each medical school have varied substantially from year to year since the AAFP began reporting this information. This article reports the average percentage for each medical school for the last 3 years. Also reported are the number and percentage of graduates from colleges of osteopathic medicine who entered Accreditation Council for Graduate Medical Education-accredited family practice residency programs, based on estimates provided by the American Association of Colleges of Osteopathic Medicine..

Special Articles: 1999 Match Results
(Fam Med 1999;31(7):465-72.)

Results of the 1999 National Resident Matching Program: Family Practice
Norman B. Kahn, Jr, MD; Gordon T. Schmittling, MS; Robert Graham, MD

The 1999 National Resident Matching Program (NRMP) results reflect continued volatility in the perceptions and career choices of physicians entering graduate medical education in the United States. A total of 117 fewer positions (155 fewer US seniors) were filled in family practice residency programs in 1999, as well as 23 fewer (29 fewer US seniors) in primary care internal medicine and 38 fewer (27 fewer US seniors) in internal medicine-pediatric programs. In contrast, nine more positions (19 more US seniors) were filled in anesthesiology and one more (10 more US seniors) in diagnostic radiology, two “marker” disciplines that have recently been market sensitive. Seventy-three more positions (but 67 fewer US seniors) were also filled in categorical internal medicine, while 30 more positions (40 more US seniors) were filled in categorical pediatrics programs, where trainees are “pluripotential” with perceived options for practicing as generalists or entering subspecialty fellowships, depending on the market. While the demands of managed care and the needs of rural and underserved populations continue to offer a market for family physicians, family practice experienced a second year of “primary care backlash” through the 1999 NRMP. In addition, current forces appear to be influencing some students to choose subspecialty rather than primary care careers.

Special Articles: 1999 Match Results
(Fam Med 1999;31(8):551-8.)

A Long-term Perspective on Family Practice Residency Match Success: 1984–1998
Bron D. Skinner, PhD; Warren P. Newton, MD, MPH

Background and Objectives: Knowing which factors predict National Resident Matching Program (Match) success is critical for medical students, student advisors, and residency faculty, but published reports have focused on a limited number of program characteristics or a small number of years.

Methods: We obtained information about region, affiliation, hospital size, population served, intern salary, and intern call schedule from the Directory of Family Practice Residency Programs for all US family practice programs from 1984–1998 and correlated them with initial Match results, using both univariate and multivariate techniques.

Results: Over 15 years, there have been substantial increases in programs and positions offered, salaries, proportion of larger programs, and reduced intern call frequency. Western region, larger program size, and community hospital affiliation were associated with a higher initial Match rate, but only 7%–19% of the variance was explained. In the late 1980s, salary had an effect, as did call in the worst Match years; in recent years, suburban programs have filled better and rural programs less well. Hospital size had no relationship to fill rates.

Conclusions: Program characteristics have a real but modest impact on initial Match rates; the significance may increase in times of decreased interest in family medicine, such as the late 1980s and early 1990s.

Residency Education
(Fam Med 1999;31(8):559-65.)


Residency Training in Mental Health: A South Carolina Family Practice Research Consortium Study
Janice C. Probst, PhD; Avie J. Rainwater III, PhD; Philip C. Michels, PhD

Background and Objectives: This study explored attitudinal, demographic, and residency training factors that affect the use of mental health (MH) interventions by family physicians.

Methods: All 872 alumni from seven family practice residency programs in South Carolina were sent a mail-back survey about MH issues. Alumni returned 400 surveys (46%).

Results: An estimated 25% of routine patient care visits required some MH counseling. Interventions categorized by respondents as “often used” included counseling plus medication (58%), referral plus medication (39%), and counseling alone (30%). When respondents assessed their residency training, only psychopharmacology received high ratings from a majority of physicians (65%). Lectures, hospital rounds, and one-on-one supervision were the most common teaching methods. The use of multiple teaching methods was associated with higher perceived training quality. Nearly two thirds (62%) of physicians were interested in continuing education in MH counseling.

Conclusions: Family physicians have positive attitudes toward MH counseling and often provide MH interventions. Physicians’ satisfaction with residency training in MH topics, however, could be improved. More MH teaching in ambulatory settings may be appropriate.

Residency Education
(Fam Med 1999;31(8):566-71.)

Students’ Evaluations of Teaching and Learning Experiences at Community- and Residency-based Practices
Janice C. Probst, PhD; Avie J. Rainwater III, PhD; Philip C. Michels, PhD

Background and Objectives: This study explored attitudinal, demographic, and residency training factors that affect the use of mental health (MH) interventions by family physicians. Methods: All 872 alumni from seven family practice residency programs in South Carolina were sent a mail-back survey about MH issues. Alumni returned 400 surveys (46%).

Methods: All 872 alumni from seven family practice residency programs in South Carolina were sent a mail-back survey about MH issues. Alumni returned 400 surveys (46%).

Results: An estimated 25% of routine patient care visits required some MH counseling. Interventions categorized by respondents as “often used” included counseling plus medication (58%), referral plus medication (39%), and counseling alone (30%). When respondents assessed their residency training, only psychopharmacology received high ratings from a majority of physicians (65%). Lectures, hospital rounds, and one-on-one supervision were the most common teaching methods. The use of multiple teaching methods was associated with higher perceived training quality. Nearly two thirds (62%) of physicians were interested in continuing education in MH counseling.

Conclusions: Family physicians have positive attitudes toward MH counseling and often provide MH interventions. Physicians’ satisfaction with residency training in MH topics, however, could be improved. More MH teaching in ambulatory settings may be appropriate.

Medical Students Education
(Fam Med 1999;31(8):566-71.)

Spiritual Perspectives and Practices of Family Physicians With an Expressed Interest in Spirituality
William H. Markle, MD

Background and Objectives: Among a growing number of articles about spirituality and medicine, there are no open-ended empirical inquiries about family physicians’ understanding of spirituality and what it might mean to incorporate spirituality into family practice. We used a qualitative methodology to investigate family physicians’ perceptions of spirituality in clinical care, the roles of their own personal spirituality, and implications for medical education.

Methods: We used qualitative content analysis on transcripts of semi-structured interviews that had been conducted with 12 family physicians, in three regions of the country, with an expressed interest in spirituality.

Results: This group of physicians reported 1) taking a vital clinical role as encouragers of patients’ spiritual resources, 2) a vital role of their personal spirituality as an underpinning of the vocation and practice of family medicine, and 3) the key roles of respectful dialogue and mentoring in medical education about spirituality.

Conclusions: Results affirm the significance of spirituality in clinical family practice for the subjects interviewed and support a tripartite model that embraces clinical approaches to the spirituality of patients and families, the spirituality of caregivers, and the qualities of spirituality in health care organizations.

Clinical Research and Methods
(Fam Med 1999;31(8):578-85.)