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March/April 2015 Annals of Family Medicine

Residency Expansion Required to Avoid Projected Physician Shortages

More than 44,000 additional will be needed by 2035 to meet the demands of a growing, aging and increasingly insured population, assuming maintenance of the current ratio of to population and current physician retirement rates, researchers find. To eliminate projected shortages, they call for a 21 percent increase in the current primary care residency production. Analyzing data from the 2010 National Ambulatory Medical Care Survey and 2010 US Census, researchers find that at current rates of physician production, there will be a shortage of more than 33,000 over the next 20 years. Specifically, they project that demographic changes and insurance expansion will require an additional 44,340 by 2035, with population growth accounting for most of the increase. They report that from 2015 to 2035, at current production rates (8,049 each year), allopathic and osteopathic graduate medical education will produce 169,029 new . Because of retiring , however, this production cannot match need, resulting in a shortage of 33,283 by 2035. The authors assert that this deficit could be eliminated by adding nearly 2,200 first-year residency positions by 2020, a 27 percent increase. The authors also note that changing care models toward smaller panel sizes would substantially increase the projected shortage.

Estimating the Residency Expansion Required to Avoid Projected Primary Care Physician Shortages by 2035

By Winstow Liaw, MD, MPH, et al

Virginia Commonwealth University, Richmond

Health Coaching By Medical Assistants Improves Glycemic and Cardiovascular Health Indicators

With primary care clinicians in increasingly short supply and overwhelmed by the expanding preventive and chronic care needs of their growing patient populations, researchers find that health coaching by medical assistants is a promising way to improve control of clinical indicators for the nation’s most prevalent chronic conditions, including type 2 diabetes, hypertension and high cholesterol. In a 12-month randomized controlled trial of 441 patients at two safety net primary care clinics in San Francisco, California, researchers found participants who receive coaching from full-time medical assistants trained as coaches were more likely to reach their goal for one or more of the conditions (hemoglobin A1c, systolic blood pressure and low-density lipoprotein cholesterol) uncontrolled at the time of enrollment compared with those receiving usual care (46 percent vs. 34 percent). Patients who received coaching were also more likely than the control group to achieve control of all conditions (34 percent vs. 25 percent). Almost twice the proportion of people in the health-coaching arm achieved goals for glycemic control compared with the usual care group (49 percent vs. 27 percent), and at the larger study site, coached patients were more likely to achieve the LDL cholesterol goal (42 percent vs. 25 percent). These findings, the authors conclude, demonstrate that medical assistants can successfully serve as in-clinic health coaches to improve glycemic and cardiovascular health indicators. Moreover, the authors add that the medical assistant health-coaching model may provide an important answer to the barriers of time, resources and cultural concordance faced by many primary care practices seeking to implement self-management support.