Wednesday, April 3, 2013
Residency match results bad for primary care (again)
Once again, though not trumpeted as much as in previous years, reports of this year's residency match results are in, and some media outlets are claiming this to be good news for primary care.
The Los Angeles Times claimed Match Day 2013 results are good for future internal-medicine patients, stating "America's future doctors are increasingly interested in become primary-care physicians--good news for America's future patients." OBGYN News' claim was my favorite: Primary care spots are hot in largest-ever Match Day.
They are basing this on a few things. First, the actual numbers of U.S. medical student graduates going into primary care fields such as internal medicine have in fact increased. For example, 3,135 students will be going into internal medicine, which is a 19% increase from 2009 and 6.6% increase from last year. However, the main source of positive news is coming from the NRMP (the folks who do the match) themselves. According to their press release:
Match results can be an indicator of career interests among U.S. medical school seniors. Among the notable trends this year:
--3,135 U.S. seniors matched to internal medicine, an increase of 194 over last year.
--1,837 U.S. seniors matched to pediatrics, an increase of 105 over last year.
--Family medicine matched 1,355 U.S. seniors, 33 more than last year. More than 95 % of family medicine positions were filled.
Based on these numbers it would seem that more students are choosing careers in primary care. However, this is not the case, and in some instances things are actually worse.
You have to look at the total number of slots as well as the percent that our US students are choosing primary care fields. In looking at match results for the last three years, it is important to note that there were almost 1000 more U.S. seniors graduating, which according to the NRMP they attribute to the rising number of U.S. students to three new medical schools graduating their first classes, as well as enrollment expansions in existing medical schools.
Despite having almost 1,000 new graduating medical students, the addition of these students to the primary care fields are limited. The real way to see what are students are choosing it to look at the percent of graduating students choosing a specific field as a percentage of U.S. grads matching. The results are pretty bleak.
There is virtually no change in student choosing internal medicine from 2011 to 2013 (18.9% to 19.1%). Family medicine, which looked to have a slight bump last year is actually down from 2011 to 2013 (8.35% to 8.26%). Peds is up from last year, but still down from 2011 (11.34% to 11.2%). One also needs to look at how many of the positions that were offered (a major increase from prior years) were filled by graduating U.S. seniors. Internal medicine, which was filled by 57% of U.S. seniors, dropped significantly to just below half! Family dipped from 48% in 2011 to 44.6% in 2013. Peds dropped by 1%.
In other words, more residency slots were offered across the board in primary care specialties, but more of these new slots were being filled by non-U.S. graduates than U.S. graduates.
Despite having three new medical schools worth of graduates, the pool of newly minted primary care physicians isn't really expanding that much.
Our U.S. seniors are not choosing primary care as a career, and if anything, are choosing primary care slightly less than previously, and certainly not more.
While internal medicine hasn't really changed, it is important to note that of those going into internal medicine, only 2% of seniors plan to go into primary care.
I blogged about this in 2011, when the media seemed to decry a boom for primary care. What I said two years ago is even more true today. This is a crisis. Many of the few primary care docs we have are retiring, leaving practice, or going cash only or retainer. If something is not done to increase the value, reimbursement, and job satisfaction of our primary care doctors; we will have no one left to care for our sick and aging population. (And before you post a comment about NPs and PAs filling this gap, those students aren't going into primary care either. A surgical PA makes more money than a primary care MD).
Matthew Mintz, MD, is a Fellow of the American College of Physicians. He is board certified in internal medicine and has been practicing for more than a decade. He is also an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients. This post originally appeared at Dr. Mintz' Blog. Conflict-of-interest disclosures are available here.
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Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.
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Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.
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Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).
db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.
Suneel Dhand, MD, ACP Member
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Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.
Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.
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Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.
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Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.
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One of the most popular anonymous blogs written by an emergency room physician.