The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Original Article

The Influence of Payer Mix and Visit Volume on NRMP Match Rates for Community-based Family Medicine Residency Programs

Authors: Robert Carlisle, MD, MPH, C. Ken Shannon, MD, PhD

Abstract

Background: With declining U.S. medical student interest in family medicine, it is important to study factors that may predict for individual residency program fill rates. Predictors of family medicine residency program match rates are few, with location by region of the country being the best predictor. Using a limited database, this study evaluated whether community-based residency program match rates are associated with patient visit volume and payer status.


Methods: An existing database of characteristics of 42 community-based family medicine residency programs was analyzed for associations of match rate with patient visit volume and with insurance payer status.


Results: Nonsignificant correlations were calculated for match rate with the following factors: patient visit volume per provider, percentage of patient visits with no insurance or with Medicaid payment, percentage of visits with Medicare payment, and percentage of visits with private third party payers. A marginal negative association of match rate with percentage of patient visits with Medicare payment was not significant when adjusted for region of the country.


Conclusions: In this study, neither patient visit volume nor payer status were predictive of match rate for community-based family medicine residency programs. Limitations to this study are acknowledged.


Key Points


* Family physicians provide a substantial amount of interpersonal, nonprocedural care to those with Medicare, Medicaid, and no insurance.


* U.S. medical graduates have drifted toward procedural-driven, higher paying specialties with less patient-visit volume.


* In this study, region of the country predicted 18.5% of the variation in match rate, a figure consistent with prior research.


* In this study, match rate was not associated with propensity of programs to care for those with no insurance or Medicaid payment, or with propensity to provide a higher volume of patient visits.


* A small negative association of match rate with propensity to care for those with Medicare payment was not observed when controlling for region of country.


* U.S. graduates do not appear to be preferentially selecting family medicine residency programs with higher compensating payer mixes or lower patient visit volumes, based on this small study.

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