New Med Students Shun Primary Care Jobs

Survey: Only 2 Percent Of Upcoming Graduates Plan To Become Primary Care Doctors

(AP)  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.

[joeybergas]

the medical field are not unknown to me. in fact, i am currently writing a book concerning this topic amongst many others. regardless of any of this, i am firmly opposed to anyone taking away the credibility of people who have spent an incredible amount of their lives getting trained, only to constantly get ****** over by the federal government, lawyers, etc.,with fear of not getting compensated for the work they do. while i do not think it takes anything special to go to medical school. i still say it takes a ton of work that alot of people would be unwilling to put in to earn the degree. anyone can do it.... and just so you know, i am aware of the universal trait of human nature in which people usually love showing someone else how wrong they are. in this case, however, you spent just as much time trying to prove to me that im an idiot who will regret his life in 30 years as i did defending myself. it wasnt until you said that doctors werent necessary that i really questioned your ideals

[joeybergas]

wl7bzh continues to ignore my comments and has classified me as a doctor with a delusion of grandeur, but has conveniently ignored the fact that I am choosing a profession that mostly involves dead people, clearly indicating that I am not trying to feed my ego with a job that others could even potentially view as god-like, such as a neurosurgeon or trauma surgeon. wl7bzh accuses me of spending lots of time to prove to him i am important, when honestly, i believe that any other human being on earth, could achieve any and everything that I have achieved in my lifetime. if you knew anything you would hear me tell my friends, constantly, that anyone can go to medical school/be a doctor if they want to. in fact, after completing third year i was nearly sickened by the narcissistic staff that I had to deal with who truly did have delusions of grandeur. i do not deny that these people exist. but i do claim that being this way rarely has an effect on people''s job performance, and actually usually ends up in them doing a better job. because their ego depends on them being a "good doctor". the delusions of grandeur in ...................................

The chickens have finally come home to roost. I remember back in the late ''60s when Ronald Reagan was governor of CA and he and his kind screamed that the tax payer should not have to pay for college, university of professional schools such as medical for any body else. He insisted on making everybody going to the university pay for it i.e. go into debt if necessary. This kind of shorted sightedness has now put everybody that goes to college - unless from a rich background, ultimately in debt. This dictates what a student is going to go school for instead of becoming a teacher, nurse, engineer, scientist, and a primary physician we now have everybody focused on careers that potentially make very large sums of money, ie. specialty physicians, MBA, and other related professions, so they can payback all this debt from going to school. The conservatives and their manipulating of the minds of the masses have again screwed us again.

Regards

radguy2

[wl7bzh]

Tarhealer5 and people like him are the reason I come here. I like to hear real responses from real people who have viable comments that matter and are appropriate to the story being discussed. If you ignore the loony ones, they might not go away but they might not get the attention they obviously crave.

Posted by YBotherAtAll at 07:12 PM : Sep 10, 2008


Oh thank you for the attention you''ve shown me oh holy one. Troll? Isn''t that a gay term?

[hypnotoad72]

Thank Lawers, Unions and Socialist''''s for this.
How many ask a doctor how much will it cost?
(only out of pocket money)
That''''s cause the INSURANCE company pays for it.
It''''s FREE!!!!!!!!!!
If everyone was forced to pay thier own health care and shop around. Prices will fall.
You think it''''s bad now...Wait till the Socialist Governmet get''''s it''''s geedy hands in it!

Posted by republic1776
----------------------

You''d help your case if you learned how to reach the same proficiency in English that Kindergartners take for granted...

And for another thing, it is NOT free. But all you want to do is spit bile everywhere. Why do you bother at all?

[ybotheratall]

wl7bzh and people like him are troublemakers, oftentimes referred to as trolls. They never have anything nice to say and they feed off the attention you all give them. Sadly, my post in included in that description but sometimes it just needs to be said. They try to use racist, bigoted and condenscending statements to get a rise out of people.

Tarhealer5 and people like him are the reason I come here. I like to hear real responses from real people who have viable comments that matter and are appropriate to the story being discussed. If you ignore the loony ones, they might not go away but they might not get the attention they obviously crave.

[wl7bzh]

hahaha...u think i think im a god because i am in medical school.
Posted by joeybergas at 06:56 PM : Sep 10, 2008


No joey...there is a difference between thinking you''re god and knowing that you have a god complex with delusions of grandeur.

That god complex of yours apparently hides a very insecure young man that has to keep telling everyone(and himself) how important his work is.

The problem is joey...like all defense mechanisms, they have a tendency to cause havoc when confronted with reality.

The reality is you have spent a good amount of time trying to convince a stranger of your importance. You have a problem.

[joeybergas]

hahaha...u think i think im a god because i am in medical school.... im going into pathology....very humble field......no attention......nobody bowing down to me......nobody around.....just me and my microscope...... in 30 years ill be fine

[wl7bzh]

wl7bzh is an idiot... end of story

Posted by joeybergas at 06:31 PM : Sep 10, 2008

Quite the contrary...

When the new wears off that medical halo of yours, you will realize what a pompous jackass you were...it may take you about 30 years....but you will look back and realize how much you did not know and how much you have really learned.

It''s been fun.

[joeybergas]

wl7bzh is an idiot... end of story

[wl7bzh]

Perhaps wl7bzh would like to spend the day with an EMS or First Responder squad, work in suboptimal conditions, risk being sprayed with contaminated blood,and receive no thanks for it.

Posted by klcfan at 06:06 PM : Sep 10, 2008

The ungrateful dreggs of mankind-no reward for all the sacrifice.

If yur trying for a position on the Holy Trinity-be advised the position was already taken. Get over yourself you pompous windbag.

[klcfan]

joeybergas, I like your question about an appropriate perceived salary for the reconstructive surgeon. I''d even back up a step and find out what the perceived appropriate compensation is for the EM personnel, the paramedics, and everyone else who puts their lives on the line every day for our emergency medical services to function so that people are safe. Perhaps wl7bzh would like to spend the day with an EMS or First Responder squad, work in suboptimal conditions, risk being sprayed with contaminated blood,and receive no thanks for it.

[wl7bzh]

Posted by TarHealer5 at 05:56 PM : Sep 10, 2008

Good for you Doc, you sound like the type physician we need more of.

[tarhealer5]

I am a family physian and the medical director for a rural health center. The primary care shortage is actually worse than these statistics indicate because many doctors coming out of medical school want to work less than full time. I worry a lot about who will take care of the aging population.

Family physicians in rural areas certainly do a lot more than refer to specialists. I care for many patients with diabetes, heart disease, asthma, and other complex problems. I work hard to make sure they get the care they need because I care about them.

A medical system with few primary care doctors will be financially unsustainable and unhealthy. We need serious health reform that addresses ( along with cost, quality, access,malpractice, customer service) the reasons that too few bright young medical students choose primary care. Primary care is not the most financially rewarding speciality but I find practicing family medicine to be a very rewarding way of life.

[wl7bzh]

wl7bzh,You moch a doctor, if he or she makes a mistake you hit paydirt.
You suffer from socialist delusional entitlement sickness.

Posted by republic1776 at 05:52 PM : Sep 10, 2008


I''m not sure exactly what you said republic, but I like it. : )

[republic1776]

wl7bzh,You moch a doctor, if he or she makes a mistake you hit paydirt.
You suffer from socialist delusional entitlement sickness.

[wl7bzh]

what is a surgeon''''s kill rate? the fact that you ask such a stupid question shows me how uninformed you are.Posted by joeybergas at 05:38 PM : Sep 10, 2008
------------

OOOH ! yasuh Missah Doctor God-You done tried to pimp somebody on a blog because they dared questioned yo holy Omnipotence.

Do you realize how pathetic and insecure you must be outside of the hospital. We don''t bow down and worship you. It must be helll not to have a subordinate to go yasuh, yasuh boss.

[republic1776]

Thank Lawers, Unions and Socialist''s for this.
How many ask a doctor how much will it cost?
(only out of pocket money)
That''s cause the INSURANCE company pays for it.
It''s FREE!!!!!!!!!!
If everyone was forced to pay thier own health care and shop around. Prices will fall.
You think it''s bad now...Wait till the Socialist Governmet get''s it''s geedy hands in it!

[joeybergas]

what is a surgeon''s kill rate? the fact that you ask such a stupid question shows me how uninformed you are... a surgeon''s kill rate? under what circumstance? emergency surgery? elective hernia repair? please ask a question that also includes the expected death rate if the surgery were not to be performed... but, since we are on this topic....what do you believe is an appropriate salary for somebody who spent 15 years after high school to become a plastic surgeon who is trained to fix your deformed *** after you get in a wreck because you were drunk

[wl7bzh]

if one day the doctors decide that working 80 hours a week is too much and decide to go on strike... i can imagine this would create a problem

Posted by joeybergas at 05:23 PM : Sep 10, 2008

For the record, when the medical profession went on strike in Israel a few years back, Israel''s mortality rate declined.

What is a surgeons'' kill rate anyway?