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.

[moosemcbush]

John McCain voices phony outrage at Med Students:

"Clearly the phrase "unneeded medical procedures" was an attack on Governor Palin and Obama should apologize. Just because the addition of Palin to my ticket was superficial eye candy much like a b_oo_b job, doesnt mean shes unneeded."

[lewiston14]

Not good as more people will be using the ER as their PR.

[lewiston14]

In some ways a PR is almost becoming useless. They write prescriptions for obvious things but most of the time they just send you over to other doctors who send you over to yet other doctors while you pay the big money for those first time visits. I had a small bump on my wrist of all places and the PR said it was a wart, go home and put some wart off on it. Months later I visited a dermatologists (on my own)when it got much bigger and found out it was cancer. So big infact an operation that put a 3%u201D hole in my wrist said they got it. Two weeks later another bump formed next to the first. Another bio showed that in fact there were still live cancer cells so he gave up and down to the bunker / radiation unit I went filling out the same useless forms. Being nuked 45 times killed its ability to reproduce Its still there just not going anywhere soon. This whole doctor thing has become a game controlled by the insurance companies.

[wl7bzh]

Primary care focus is mostly health promotion/disease prevention. This usually involves lifestyle management.

Now that it has become politically incorrect to suggest that someone''s lifestyle is unhealthy, primary care becomes an even bigger hassle.

It becomes expedient for physicians to do residencies where the patient already has the disease and has to follow protocol. Essentially specialty care has become a "delayed sin tax".

As always CBS, feel free to censor.

[ljb6599]

When are people going to wake and realize that our current insurance based health care system does not work anymore.I work in mental health and we have the same propblem.Psychiatrists are also tired of dealing with insurance companies and in many areas of the country there are shortages.Whether you like it or now it time to strongly consider a universal health care system before it is to late.The insurance based health care system is an experiment that has failed.

[docpeter-2009]

From the above article, "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."
________________

Not to mention the less $$ for the work done, more insurance hassels, having to be gate keepers only having to refer the patient to a specialist anyway so that the insurance company will pay for any treatment other than "take two aspirins and call me in the morning" while their CEOs pocket multi-million $$ from the insured.

[yongamerica]

What this confirms is the majority of doctors went to med school to make lots of money first and to be a doctor second. Medical schools needs to devise a way to filter these kids from the profession as it is this mentality that creates lackadaisical medical practices and sums up into astronomical medical insurance. Poor doctors = High doctor insurance premiums + substandard health care.

[rmsdm4]

If you think its bad now weight till we get socialized medicine. I would rather deal with someone wanting to make a profit that a gov''t employee and that is what doctors and nurses will become.

[sepa2]

This is not sustainable. Any profession there have to be more average pratitioners than specialist. So who is going to absorb all these "specialists"? The high %GDP swallowed by health care will even go higher

[sepa2]

"Not good as more people will be using the ER as their PR."
That is the idea. MORE Money. Cold Cash. More spending on health care. Higher Insurance premiums. Less jobs or jobs without insurance benefits. Cost passed on to consumer. Lower sales. Again Less jobs.

[dantt-2009]

Most people that want to be doctors do it for money and prestige. They want to make as much money as they can, not to serve or help people. That is the problem with medicine base in capitalism. All the other are excuses. Medical Schools need to be better getting students that want to practice medicine for the right reasons, to help people and serve. When these kids apply to med schools they all say they will work with the poor, etc, but in reality they all want to just make money and do not care about people with needs.

[dantt-2009]

Also look who are people getting into med schools, people who have families with conections and money. They have the fancy letters of recomendatios from other doctors, the fancy trips overseas. More people who are comming from poverty needs to be doctors so they understand people with no health insurance and real needs

[joeybergas]

as far as i can see not a very scientific study... easily more than 2% of med students go into internal medicine/family medicine, not to imply that they are the same thing..... you guys go through med school, work for 3-4 years 80+ hrs/ week and get paid minimum wage for it, and then please expect doctors to settle for low wages....you have no idea how hard it is, and how much your life is manipulated.. also, blame the lawyers for making the lives of doctors hell on earth.....practicing medicine isnt practicing medicine anymore

[dogsoul]

"Most people that want to be doctors do it for money and prestige. They want to make as much money as they can, not to serve or help people. That is the problem with medicine base in capitalism. All the other are excuses. Medical Schools need to be better getting students that want to practice medicine for the right reasons, to help people and serve. When these kids apply to med schools they all say they will work with the poor, etc, but in reality they all want to just make money and do not care about people with needs. "

You are an idiot.

Of ALL the professions that absolutely DESERVE to reward people with high salaries, this is it. They sink themselves into debt - expend unbelievable amounts of time & energy into many years of study - work exhausting hours for years AFTER that, for not much money - finally are able to pay off their debts - and take care of not only America''s sick, but with their advancements have been the backbone of medical improvements throughout the world...

And according to you, they shouldn''t make much money. What do YOU do for a living you pathetic socialist nimrod...

[dogsoul]

"As far as the term ''''socialized'''' medicine, it''''s working just fine in many, many countries around the world."

yeah right... that''s an absolute lie. Socialized medicine is an abismal failure in every country that''s running it....

that''s a fact

[dogsoul]

Dear liberal socialist idiots:

What happens when you issue your socialist controls over the medical industry? Well, pretty much the same thing that happens in places like Canada, France & England -

- Quality goes thru the floor
- Advancements slow to a crawl ( the US alone is credited with producing over 50% of the major new medical advancements in the last 20 years, and is sited as having significant influence in over 80% of major advancements in the last 30)
- Like Medicare, it ends up in financial ruin

And when you take away a doctor''s ability to make really good money??? Well golly gee liberals? Suddenly you end up with a shortage of doctors, funny how that works isn''t it? And.... hmmmm.... combined with your other methods that have plainly failed in other countries.... gee whiz, what do you suppose happens then?

Liberals - socialist idiots, all of them - move to France where you belong.

[gce65]

Unfortunately, our government and citizens have made medicine a business for profit rather than a social asset that benefits us all.

Health care has becomes a privilege for those who can afford it. Everyone else is left without it.

We are the only industrialized nation who approaches it this way, and it will sink us. Meanwhile, all the other nations will watch and say, "We told you so."

[gce65]

Most every country that has followed the "socialized medicine" model, if you want to call it that, is basically happy with it. That''s not to say they wouldn''t change certain aspects if given the chance. But most are happy with the health care they receive under those systems.

But don''t take my word--or anyone else''s word--for it. Look it up yourself. Do a simple online search for satisfaction and socialized medicine.

Here''s a link from a Wall St Journal Marketwatch story saying of 10 industrialized nations, the US has the least satisfaction with it''s health care system:

http://www.marketwatch.com/news/story/americans-rate-us-health-care-system/story.aspx?guid=%7B86F29D04-FC2D-466F-ADF6-2435468CE406%7D

[dogsoul]

"Health care has becomes a privilege for those who can afford it. Everyone else is left without it."

90% of Americans are either insured, about to be insured, or can afford insurance or an insurance program, but voluntarily opt out.

"We are the only industrialized nation who approaches it this way, and it will sink us. Meanwhile, all the other nations will watch and say, "We told you so."

Other nations are desperately trying to climb out from under their failing socialized health care disasters by trying to adopt (or re-adopt) many of the practices of the United States - and yet while we sit here & plainly view these abismal failures unfold, liberals want us to jump into the pit...

The United States alone accounts for most of the world''s medical advancements in the last 30 years, for a very good reason - because we''ve not listened to these socialists. We must focus on reigning in the true bloodsuckers, the lawyers - ignore these socialist idiots, and formulate a plan to cover the remaining 10%...

Liberals - if you live in a place called reality, you won''t find any...

[dogsoul]

...or you can look over THIS link & get a little closer to the truth about socialized healthcare...

http://www.angelfire.com/pa/sergeman/issues/healthcare/socialized.html

[gce65]

Please don''t mistake what I''m saying. American medicine is not inferior. But the way we finance it is.

[dogsoul]

split up... try this

http://www.angelfire.com/pa/sergeman/issues/healthcare/socialized.html

[dogsoul]

...well, if you''d like a preview of how well socialized financing works - look at medicare

[payasyougo]

Let me foretell the future of a medical student...

Run up 150k in debt while completing arguably the longest and most intense curriculum with the greatest responsibility....

...only to be told you make too much money, or you make a perceived mistake and your insurance company settles with John Edwards because its cheaper than defending that you didn''t make a mistake, or you get to look forward to managed health care.

Why would anyone go down that path?

[joeybergas]

hahahah this dude thinkgs that incompetent physicians are the ones that fuel the frivolous lawsuit....... lawsuit hungry society we live in????? stupid ***.... youre probably a lawyer.. nothing is harder than being a doctor.....period

[klcfan]

I feel as a senior medical student it is my job to refute some of the inaccurate information and maligning of my colleagues and myself by the other posters. To dantt, I''ve been in school 80% of my life to attain the goal of becoming a physician. My dad is a laborer, mom is disabled, and they make $40K per year. I''ve never traveled overseas, and want more than anything to in the literal sense, make people feel better. My story is by no means unique. To go through so many years of h e l l in order to put MD after our names is not something we take lightly. I could have a nice house for the amount of money I currently owe Uncle Sam for student loans, and I''ll be spending the next 3 years working for what amounts to less than minimum wage during residency. Yet I do it so I can take care of YOU and your loved ones. Don''t disparage us; you may need a good doctor one of these days when somebody plants their fist in your face.

[wl7bzh]

Don''''t disparage us; you may need a good doctor one of these days when somebody plants their fist in your face.

Posted by klcfan at 05:06 PM : Sep 10, 2008

Very professional of you Doc-Guess it must be some of that Doc/God complex we hear so much about. Tell you what-if you really want to feel important, you can always find some nurse to tell "if you wanted to be a Doctor(God) you should have gone to medical school" That''ll put the uppity little byotch in her place.

[joeybergas]

i am also a senior medical student and i am with klc fan.. you guys apparently have preconceived notions about doctors and their supposed god complexes....yes....there are a good number of narcissistic doctors......but.... this rarely, if ever, interferes with them doing their jobs..... i can assure you that it would be a grave mistake for you guys to consider dropping the wages of physicians... the backlash would be catastrophic..... how much money did you pay to get your degree? i paid 150,000..... you guys have no idea how hard being a doctor is....go spend a day with a general surgeon and see the infinite number of things he/she has to do that day.... you people highly underestimate what training this takes, and if you think youre going to be able to continue to create people who are capable of this kind of work by treating them worse than they are already being treated....you are truly, gravely mistaken...... i would be very careful with this line of thinking.... 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

[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?

[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

[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!

[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]

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

[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. : )

[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.

[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]

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.

[joeybergas]

wl7bzh is an idiot... end of story

[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]

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]

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.

[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.

[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?

[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?

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

[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 ...................................

[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