In 2020, the emergence of the Sars-CoV-2 virus (COVID-19) placed the country’s health care system under a new microscope. Failures in coordinating the health care response, along with the parallel crises of access to care and inequities of treatment have since highlighted inherent weaknesses in the current state of health care. This also shone light on the longstanding inattention to primary care. Family medicine was both called upon and impacted in many ways, including requests to cover additional care in hospitals, emergency departments, and other settings, pivot rapidly to telehealth without additional resources, and continue providing care in their offices without basic personal protective equipment (PPE). The financial challenges of smaller size and dependence on fee-for-service payment were revealed as family physicians were tasked first to survive office shutdowns and then to take on sometimes overwhelming numbers of COVID-19 patients. The risk associated with these visits was high—ultimately resulting in family physicians comprising approximately one-third of all physician COVID-19-related deaths.⁴

Family medicine has also been essential to advances in health equity and addressing social determinants of health. As the nation’s most widely distributed physician discipline, family physicians also provide the majority of care for underserved urban and rural populations, and often act as a first-contact for health-related issues.⁵

This Factbook describes the current state of family medicine in the United States through the presentation of data from sources including surveys and research executed by the American Board of Family Medicine (ABFM). The intention of the Factbook is to characterize family medicine through lenses of physicians, patients, and graduate medical students. Providing a compendium of this data is critical to help guide researchers, decision makers, and other stakeholders at a time when health care delivery systems continue to evolve after the COVID-19 pandemic.

Family Medicine: A Brief History

In 1969, the American Board of Family Practice (ABFP) was approved by the American Board of Medical Specialties (ABMS) to be the 19th medical specialty board in the United States.⁶ The ABFM was the first board to issue time limited certifications, requiring physicians to demonstrate ongoing medical knowledge via examination every seven years. In 2003, ABFM became the first specialty board to issue certification which required maintenance of certification (continuous certification), doing so every 7-10 years.⁷ Family medicine is a primary care specialty, that stems from early generalist physicians, and provides first point-of-contact care to patients without the need for a referral like many other specialties.⁸ Family physicians provide the majority of care for underserved rural and urban populations in the United States, and have one of the largest scopes of practice in health care.⁵ They are the only specialists qualified to treat most health-related issues and ages ranging from newborns to seniors.⁵ This breadth of practice requires an understanding of social determinants of health and community health, the building of trust between the patient and physician, and the responsibility of being a patient’s first form of contact for health care needs.⁵ Underinvestment in primary care, and subsequently family medicine, creates issues regarding patient access to necessary preventive health services and leads to declining numbers of primary care physicians in the workforce and creates reduced access to a broad range of services to patients who need them the most.⁹

Family Medicine Factbook: Data Sources and Approach

This snapshot of the family medicine workforce represents ABFM Diplomates as of January 1, 2022, following a uniquely challenging and transformative period during the COVID-19 pandemic. In January 2022, there were more than 100,000 family medicine Diplomates, representing all physicians who held current ABFM certification status. This status is initially earned by completing residency training, obtaining a full medical license, and by passing the Family Medicine Certification Examination, and is maintained by continuous family medicine Certification. To create the Factbook, we used data from responses to ABFM questionnaires received from January 1, 2016, to January 1, 2022, to describe the trends and current state of family physician demographics (see Methods Appendix).

The importance that this Factbook holds is two-fold. It offers insight and commentary on the current state of family medicine amidst a crucial time for health care system reflection and reform, and following the COVID-19 pandemic. Using real time data and analysis, topics of interest regarding overall patient and physician well-being are touched upon. In addition, this Factbook is strategically organized to optimize information recall and comprehension, allowing the Factbook to act as a one-stop-shop reference for discussions of the family medicine workforce, with the goal of simplifying the compendium of family medicine data to impact further research, policy reform, advocacy, and education.