The proportion of international medical graduates (IMGs) serving as primary care physicians in rural underserved areas (RUAs) has important policy implications. We analyzed the 2000 American Medical Association Masterfile and Area Resource File to calculate the percentage of primary care IMGs, relative to U.S. medical graduates (USMGs), working in RUAs. We found that 2.1 percent of both primary care USMGs and IMGs were in RUAs, where USMGs were more likely to be family physicians but less likely to be internists or pediatricians. IMGs appear to have been no more likely than USMGs were to practice primary care in RUAs, but the distribution by specialty differs.T h e c o u nc i l o n g r a d uat e m e di c a l e d u c at i o n (COGME), Institute of Medicine (IOM), American Medical Association (AMA), and other national organizations have concluded that there is an oversupply of physicians but that they are poorly distributed geographically and by specialty.1 This surplus is the result of efforts since the early 1970s to expand the U.S. physician workforce that resulted from a perceived shortage.2 These efforts included increasing domestic production through funding for new medical schools and postgraduate training programs, as well as purposefully increasing the number of international medical graduates (IMGs) who came to the United States for postgraduate training.3 As a result, from 1970 to 1994 the U.S. population increased 21 percent, the number of medical students increased 66 percent, and the number of residents and fellows increased 259 percent. Recommendations from these bodies to reduce the subsequent physician oversupply include reducing residency positions and curbing the number of IMGs. Recommendations to address specialty maldistribution include increasing the percentage of residency graduates practicing one of the primary care specialties: family and general practice, general internal medicine, and general pediatric medicine. 5 The percentage of residents who are IMGs slowly increased from 25.5 percent in 1996 to 26.4 percent in 2000 but dropped back to 25.5 percent in 2001. 6 The composition of the IMG population in residency training has also shifted, with an increasing proportion of U.S. citizens who graduated from medical schools outside the United States. While the number of matching foreign-born IMGs (FBIMGs) obtaining residency positions through the National Residency Matching Program from 1997 to 2001 decreased 18 percent, the number of U.S.-born IMGs (US-IMGs) increased 64 percent.7 Recent reductions in IMGs, specifically FBIMGs, could be attributed to a decrease in residency training positions as a result of the Balanced Budget Act of 1997, the introduction of a single-site Clinical Skills Assessment Test (CSAT) required for IMGs, and a reduction in the number of J-1 visas. 8 The extent to which IMGs become primary care physicians and locate in rural underserved areas (RUAs) has important policy implications. Some studies suggest that IMGs are more likely than USMGs are to locate ...

Applicants whose departmental advisors serve on a residency selection committee have less confidence in the advising relationship. These interactions may have adverse effects on the clinical and professional development of medical students.

These are historic times for family medicine. The profession is moving beyond the visionary blueprint of the Future of Family Medicine (FFM) report while working to harness the momentum created by the FFM movement. Preparing for, and leading through, the next transformative wave of change (FFM version 2.0) will require the engagement of multigenerational and multidisciplinary visionaries who bring wisdom from diverse experiences. Active group reflection on the past will potentiate the collective work being done to best chart the future. Historical competency is critically important for family medicine's future. This article describes the historical context of the development and launch of the FFM report, emphasizing the professional activism that preceded and followed it. This article is intended to spark intergenerational dialog by providing a multigenerational reflection on the history of FFM and the evolution that has occurred in family medicine over the past decade. Such intergenerational conversations enable our elders to share wisdom with our youth, while allowing our discipline to visualize history through the eyes of future generations. (J Am Board Fam Med 2014;27:839 -845.) Keywords: Health Policy, Medical Education, Primary Health CareThere is an urgent need for a strong and sustainable US health care system. Family medicine is uniquely positioned to lead efforts to help our nation achieve the triple aim of better health care, improved population health, and lower health care costs. [1][2][3][4][5] Reflections on the history of family medicine are central to our dialog about the future, including a critical review of key historical documents, such as the Future of Family Medicine (FFM 1.0) report. [6][7][8][9] Reviewing the history surrounding the creation of the FFM 1.0 report will help our profession prepare for the next wave of transformative recommendations (FFM 2.0).10 This article presents a multigenerational perspective on the historical context of the development and the launch of the FFM 1.0 report, emphasizing the professional activism that preceded and followed it. It is intended to spark continued intergenerational dialog on the evolution that has occurred in family medicine over the past decade as well as to provide historical context for critically interpreting and building an action plan for FFM 2.0 recommendations. Effective change will require the engagement of multigenerational and multidisciplinary visionaries who bring wisdom from diverse experiences. Historical competency is imperative; active group reflection on the past will potentiate the collective work being done to best chart the future.Historical Context, Development, and Launch of the FFM 1.0 Report Family medicine derived from general practice. Before the 20th century, the standard medical practice This article was externally peer reviewed.

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