Family medicine sees 8th consecutive year of Match losses

Lifestyle issues are a major reason, but primary care physicians promote rewards of their specialty and tell students they aren't always chained to a pager.

By Myrle Croasdale — Posted April 4, 2005

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Dave Winchester, a senior at the University of South Florida College of Medicine in Tampa, has heard all the arguments against entering primary care medicine -- the lower relative pay and less controllable time demands. But Winchester said he had to follow his heart.

"I like the intellectual challenge of internal medicine," said Winchester, one of 25,300 applicants to the National Residency Match Program who got their results March 17. Winchester got his first pick, the University of Virginia. As an internist, "you have the opportunity to do some invasive procedures, and you spend a fair amount of time doing detective work to figure out what is going on," he said.

Leaders in primary care wish there were more students who thought like Winchester. There's been a downtrend in the specialties that make up primary care in recent years, as U.S. medical students, overwhelmed with debt or seeking a specialty promising a better work-life mix, gravitate toward the subspecialties.

The results of this year's Match showed a decrease for the eighth consecutive year in the number of U.S. seniors from allopathic medical schools heading into family medicine. In internal medicine, the number of U.S seniors held near steady, compared with last year, as did obstetrics-gynecology, while pediatrics saw a small uptick.

Over the past five years, the number of U.S. seniors is down for all of the fields in primary care, although internal medicine, ob-gyn and pediatrics saw small net gains when including international medical graduates.

The American Academy of Family Physicians and American College of Physicians, in particular, are seeking to reverse this slide.

"There's the concern that being the physician responsible for the ultimate care of the patient means life becomes a little more unpredictable in terms of hours," said Steven E. Weinberger, MD, senior vice president for medical knowledge and education for the ACP. "But there are wonderful ways to build models of practice to counter that."

Making a choice

A record 22,221 U.S. medical school seniors and other applicants were matched to first- and second-year residency positions this year, the most in nearly 20 years. More than 14,700 U.S. allopathic medical school seniors applied to the Match, making up 58% of total applicants, which include international medical graduates and osteopathic medical graduates.

Prospective residents continued to flock to subspecialties, with dermatology, emergency medicine, general surgery, orthopedic surgery and plastic surgery remaining highly competitive. In family medicine, U.S. allopathic seniors took 41% of the available slots, filling 82.4% of total family medicine residency slots. In internal medicine, 97% of positions filled, with 56% of them going to U.S. seniors.

Some say students going instead toward subspecialties are moving in the opposite direction of what the public actually needs.

Mary E. Frank, MD, president of the AAFP, contends that a healthy public will require more primary care physicians, not fewer, citing a recent study linking lower mortality rates to regions with more primary care doctors.

And, as the Bush administration calls for more public health centers to shore up the health care safety net, more family physicians are going to be needed, she said. Family physicians make up 75% of the physicians who staff these clinics.

Dr. Weinberger said that although primary care organizations are trying to improve issues relating to pay and lifestyle, they also want to inform students that there are other rewards.

"Another important issue is giving students the sense of the long-term gratification of the longitudinal care of patients," he said. "I think that is offered nowhere else as extensively as in primary care. It's incredibly gratifying, but students may not get a sense of that in the short time they are working in the field."

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Family medicine positions on the decline

Fewer U.S. medical school seniors are seeking careers in family medicine these days. This year, only 8% of seniors graduating from allopathic medical schools picked a family medicine residency. Family medicine residencies have declined now for eight years running.

Family medicine positions
Offered Filled U.S. seniors
1997 3,262 2,905 2,340
1998 3,293 2,814 2,179
1999 3,244 2,683 2,015
2000 3,183 2,584 1,817
2001 3,074 2,346 1,503
2002 2,962 2,342 1,399
2003 2,920 2,227 1,226
2004 2,864 2,256 1,185
2005 2,761 2,275 1,117

Source: National Resident Matching Program

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External links

National Resident Matching Program data for 2005, in pdf (link)

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