Abstract
CONTEXT: Shortages of primary care (PC) physicians threaten access, quality, and equity in US healthcare. Policy solutions require insight into complex patterns of training from medical school graduation through specialty training into PC careers. OBJECTIVE: Create a quantitative Sankey diagram of the flow of US physicians from medical school graduation through postgraduate training into PC specialties: family medicine (FM), general internal medicine (IM), and general pediatrics (Peds). Quantify proportions who initially train in PC but leave to train in other fields. STUDY DESIGN AND ANALYSIS: Retrospective cohort design. DATASET: AMA Physician Masterfile and Historical Residency File (2024). POPULATION STUDIED: US physicians who graduated from medical school 2001-2015. INTERVENTION: None. OUTCOME MEASURES: Completion of specialty training programs. RESULTS: Physician graduates totaled 353,590, (2001–2015), including MDs - 92.1%, (325,578), DOs - 8% (28,012), IMGs - 21% (67,231). 47% (165,386) were women. Sankey diagram displays flows physicians followed through their first and final postgraduate training programs. FM was initial training for 41,795 (12%) of all physicians and 95% (39,520) stayed in FM. Few later trained in hospice & palliative care medicine (0.9%, 360), general preventive medicine (0.4%, 186), and emergency medicine (0.3%, 144). IM was initial training for 118,361 (34%), but 46,367 (39%) left PC to later train in IM subspecialties. Another 23% (27,526 ) trained in other fields: diagnostic radiology (5%, 6,241), anesthesiology (4%, 4,670), neurology (4%, 4,260), dermatology (3%, 3,295), ophthalmology (3%, 3,089), physical medicine & rehabilitation (1.6%, 1,851), radiation oncology (1.1%, 1,257). Peds was initial training for 37,028 (10%), but 33% (12,099) left PC to later train in Peds subspecialties and another 7% (2,688) in other fields: child neurology (2%, 899), allergy & immunology (2%, 728). Only 5,013 (1.4%) of physicians initially trained in combined IM/Peds programs; 68% (3396) stayed in PC, including 97 (1.9%) who later trained in other PC programs. Others (32%, 1697) left PC to train in IM or Peds subspecialties, emergency medicine, or other fields. CONCLUSIONS: Family medicine residency training is the most direct preparation for PC. Following training in IM and Peds, many trainees leave PC to train in subspecialties and other fields. Further study of practice patterns following training needs to assess sustained PC careers.