Department of Family Medicine, Medical College of Georgia, Augusta University, Augusta, GA.
Family Medicine Residency, Carl R. Darnall Army Medical Center, Fort Hood, TX.
Fam Med. 2022 Jul;54(7):522-530. doi: 10.22454/FamMed.2022.837424.
There is an ongoing shortage of primary care physicians in the United States. Medical schools are under pressure to address this threat to the nation's health by producing more primary care graduates, including family physicians. Our objective was to identify institutional characteristics associated with more medical students choosing primary care.
We conducted a systematic literature review with narrative synthesis to identify medical school characteristics associated with increased numbers or proportions of primary care graduates. We included peer-reviewed, published research from the United States, Canada, Australia, and New Zealand. The existing literature on characteristics, including institutional geography, funding and governance, mission, and research emphasis, was analyzed and synthesized into summary statements.
Ensuring a strong standing of the specialty of family medicine and creating an atmosphere of acceptance of the pursuit of primary care as a career are likely to increase an institution's percentage of medical students entering primary care. Training on regional campuses or providing primary care experiences in rural settings also correlates with a larger percentage of graduates entering primary care. A research-intensive culture is inversely correlated with primary care physician production among private, but not public, institutions. The literature on institutional financial incentives is not of high enough quality to make a firm statement about influence on specialty choice.
To produce more primary care providers, medical schools must create an environment where primary care is supported as a career choice. Medical schools should also consider educational models that incorporate regional campuses or rural educational settings.
美国目前存在初级保健医生短缺的问题。医学院正面临着通过培养更多的初级保健毕业生（包括家庭医生）来应对这一威胁国家健康的挑战的压力。我们的目的是确定与更多医学生选择初级保健相关的机构特征。
我们进行了系统的文献综述和叙述性综合，以确定与初级保健毕业生人数或比例增加相关的医学院特征。我们纳入了来自美国、加拿大、澳大利亚和新西兰的同行评审、已发表的研究。对包括机构地理位置、资金和治理、使命和研究重点在内的现有特征文献进行了分析和综合，形成了总结陈述。
确保家庭医学专业的强大地位，营造一种接受以初级保健为职业的氛围，可能会增加机构中选择从事初级保健的医学生比例。在区域校区进行培训或在农村地区提供初级保健体验也与更多毕业生选择初级保健相关。以研究为重点的文化与私立机构而非公立机构的初级保健医生培养呈负相关。关于机构经济激励的文献质量不够高，无法就其对专业选择的影响做出明确的陈述。
为了培养更多的初级保健提供者，医学院必须创造一个支持初级保健作为职业选择的环境。医学院还应考虑采用纳入区域校区或农村教育环境的教育模式。
