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Fewer American medical students choosing primary care
By Carla K. Johnson
Associated Press
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CHICAGO -- Only 2 percent of graduating medical students say they plan to work in primary care internal medicine, raising worries about a looming shortage of the first-stop doctors who used to be the backbone of the American medical system.

The results of a new survey being published Wednesday suggest more medical students, many of them saddled with debt, are opting for more lucrative specialties.

Just 2 percent of nearly 1,200 fourth-year students surveyed planned to work in primary care internal medicine, according to results published in the Journal of the American Medical Association. In a similar survey in 1990, the figure was 9 percent.

Paperwork, the demands of the chronically sick and the need to bring work home are among the factors pushing young doctors away from careers in primary care, the survey found.

"I didn't want to fight the insurance companies," said Dr. Jason Shipman, 36, a radiology resident at Vanderbilt University Medical Center in Nashville, Tenn., who is carrying $150,000 in student debt.

Primary care doctors he met as a student had to "speed to see enough patients to make a reasonable living," Shipman said.

Dr. Karen Hauer of the University of California, San Francisco, the study's lead author, said it's hard work taking care of the chronically ill, the elderly and people with complex diseases - "especially when you're doing it with time pressures and inadequate resources."

The salary gap may be another reason. More pay in a particular specialty tends to mean more U.S. medical school graduates fill residencies in those fields at teaching hospitals, Dr. Mark Ebell of the University of Georgia found in a separate study.

Family medicine had the lowest average salary last year, $186,000, and the lowest share of residency slots filled by U.S. students, 42 percent. Orthopedic surgery paid $436,000, and 94 percent of residency slots were filled by U.S students.

Meanwhile, medical school is getting more expensive. The average graduate last year had $140,000 in student debt, up nearly 8 percent from the previous year, according to the Association of American Medical Colleges.

Another likely factor: Medicare's fee schedule pays less for office visits than for simple procedures, according to the American College of Physicians, which reported in 2006 that the nation's primary care system is "at grave risk of collapse."

Lower salaries in primary care did not deter Dr. Alexis Dunne of Chicago, who is 31 and carrying $250,000 in student debt.

Last year, a parade of specialists couldn't solve the mystery of her mother's weight loss, fevers and severe anemia. Finally, an internist diagnosed a rare kidney infection. The kidney was removed, and Dunne's mother has felt fine since.

Watching her mother go through the health crisis affirmed her decision to go into primary care. She also enjoys being "the point person" for her patients.

"You become so close to them you're almost like a family friend," said Dunne, who completed her residency at Chicago's Northwestern Memorial Hospital in July.

She also found inspiration from the doctors she met during training: "They were the ones who would sit at a patient's bedside and spend more time with them rather than running off to surgery."

A separate study in JAMA suggests graduates from international medical schools are filling the primary care gap.

About 2,600 fewer U.S. doctors were training in primary care specialties - including pediatrics, family medicine and internal medicine - in 2007 compared with 2002. In the same span, the number of foreign graduates pursuing those careers rose by nearly 3,300.

"Primary care is holding steady but only because of international medical school graduates," said Edward Salsberg of the Association of American Medical Colleges, a co-author of the study. "And holding steady in numbers is probably not sufficient when the population is growing and aging."

And as American students lose interest, teaching hospitals will probably become less interested in offering primary care programs, said Dr. David Goodman, associate director of the Center for Health Policy Research at Dartmouth Medical School.

In a JAMA editorial, Goodman called on Congress to create a permanent regulatory commission to encourage training for needed specialties. U.S. teaching hospitals now receive $10 billion a year from the government to train doctors "with virtually no accountability," he said.

The coordinated care provided by primary care doctors can keep costs down by preventing harmful drug interactions, unneeded medical procedures and fragmented specialty care, Goodman said.

The Web-based survey was done at 11 medical schools with demographics and training choices similar to all U.S. medical students.

Take a look
Dr. Alexis Dunne talks with patient Michael McCoy, right, at Northwestern Memorial Hospital on Monday in Chicago, where she plans to be a primary care doctor. Only 2 percent of nearly 1,200 fourth-year medical students said they plan to work in primary care internal medicine, according to a new survey. That's down from 9 percent in a similar survey in 1990. (AP Photo/M. Spencer Green)
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Reader comments on this story - 6 total

Note: All views and opinions expressed in reader comments are solely those of the individual submitting the comment, and not those of the Pantagraph or its staff.

Shared Thought wrote on Sep 10, 2008 12:13 PM:

" Legislation could be passed requiring that every person who, either in getting through medical school itself or in getting their higher education preceding medical school, were financed at least in part by any government grant or loan, must begin their medical careers by serving at least five years as a primary-care doctor before going on to a specialty. ...Also, to encourage more doctors to remain in primary care, federal & state government payment systems to doctors such as Medicare and Medicaid should be paid promptly. (When a state sometimes makes its doctors and pharmacists wait a couple of full months or longer to receive reimbursement for services provided, then the state is, in effect, extracting an interest-free loan from a small business, the pharmacy or doctor, that no other business in the state is being subjected to.) "

Citizen#9 wrote on Sep 10, 2008 11:38 AM:

" This issue, like most others, is full of scapegoats. Greedy lawyers, doctors, drug and insurance companies, etc. At the same time we live in a country where people eat too much, drink too much, smoke too much and exercise too little (if at all) and think they're entitled to complain about the health care system when they don't get everything they want, when they want it, on someone else's dime! If you want to "reform" something, reform that. "

Meh wrote on Sep 10, 2008 11:20 AM:

" Reason, why bust out the partisan rhetoric when the article gives a much simpler explanation - MONEY. If you can't make enough to cover your student loans and your lifestyle, then you do something out. Its doubly simple when you are essentially choosing more money or less money with the same amount of work.

anchor, why are you scared to try the alternative? Do you consider our current system to be working really well? (See article above.) "

anchor wrote on Sep 10, 2008 10:35 AM:

" And do Dems think socialized medicine will help or hurt this trend? You and I will be left with the "C" student Doctors and only the wealthy will be able to afford optimal health care outside of the "system". "

WorkinTheOpinionBoard wrote on Sep 10, 2008 10:24 AM:

" There's just no incentive be a primary care doc anymore. Like stated, the pay "sucks" and it's harder to get money. "

Reason wrote on Sep 10, 2008 9:56 AM:

" Thank you Trial lawyers of america. (the largest contributors to the democratic party.) "
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