Financing graduate medical education in family medicine.

Family practice residency programs differ fiscally from residency programs in most other specialties because they have limited income-generating potential. The present review demonstrates that the typical family practice residency program has been fiscally solvent as a result of receiving approximately one-third of its income from state and federal appropriations. The level of such support plateaued in the 1980s and programs have not continued to expand despite an ongoing shortage of family physicians. Today, declining Medicare payments to hospitals threaten hospitals' contributions to family practice residency programs. The ability of family practice residency programs to meet the continuing need for family physicians will depend upon the development of specific state and federal policies that provide fiscal incentives to maintain and expand family practice residencies.