Med school seniors headed for primary care see a challenging future

After Match Day, they say being more involved in patients' lives and health overshadow issues that drive some graduates to other specialties.

By Brian Hedger — Posted March 30, 2009

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Classmates Mark Anderson and Marlana Li clasped their envelopes on Match Day, full of hope and uneasiness about their future in medicine.

Like other graduating seniors at Loyola University Chicago Stritch School of Medicine, the two on March 19 learned where they will spend the next several years of residency training. They chose primary care at a time when family medicine is struggling to attract new physicians.

There were 101 fewer family medicine positions available in the Match this year, and the number of U.S. seniors selecting the specialty decreased by 85 from 2008. Since 1997, the number of U.S. seniors matching in family medicine has dropped by more than half. Lower pay and longer hours are among the reasons cited for avoiding the specialty.

Yet Anderson, Li and others say they want to be family physicians, in part because of the lifelong relationship formed with patients and the satisfaction that comes with it.

"I didn't go into medicine for the money," said Li, who will do her residency at the St. Anthony Family Medicine Residency Program in Westminster,Colo. "I went into it because I genuinely care about people, and I want to make a difference."

Anderson will head to the La Grange Memorial Family Practice Residency Program in suburban Chicago, saddled with about $220,000 in loans.

"There are people saying, 'I could have gone into family medicine or radiology, and I picked radiology because the salary would be double or triple what I'd get in family medicine,' " Anderson said. "But family medicine doctors are not starving. It's a good job. Will it take me 20 years instead of 10 to pay off my loans? Maybe. Will I drive a Honda instead of a new Mercedes? That's not really something that has been important or mattered to me."

Match Day record

A record-setting 29,890 applicants participated in Match Day -- 1,153 more applicants than last year. This year, 15,638 U.S. seniors at allopathic medical schools were matched with residencies. Osteopathic graduates, international medical graduates and first-year residents also participated.

Among this year's matches, dermatology, neurological surgery, orthopedic surgery and otolaryngology were sought-after residencies. The number of U.S. seniors choosing anesthesiology almost doubled to 612 from 326 in 2005.

While family medicine has struggled for graduates, the news isn't much better for internal medicine. The number of U.S. allopathic students matching for internal medicine has declined by about 1% each of the past two years. That's despite an increase in residencies offered each year since 2005.

The American College of Physicians and the American Academy of Family Physicians say higher payment rates for primary care physicians and debt relief from loans are two key ways to make primary care more attractive to new physicians.

As program director and CEO of the Family Medicine Residency of Idaho in Boise, Ted Epperly, MD, is impressed with graduates who decide to enter primary care.

"The quality of the kids who are choosing family medicine is outstanding," said Dr Epperly, who is also president of the AAFP. "They've got heart, and they see this as an obligation of service. We just need more of them."

Dr. Epperly said that to meet expected primary care needs by 2020, the ideal number of family medicine residency slots per year should be near 3,500. This year, there were 2,535 available in the Match.

"We have to start producing more family physicians," he said. "We're headed toward a total crisis in primary care in this country very soon."

The personal side of being a family doctor is what attracted Mish Mizrahi, a senior at the University of California, Los Angeles David Geffen School of Medicine. She landed a residency at the Ventura County Medical Center Family Medicine Residency Program, not far from where she grew up in Los Angeles.

She can't wait to start.

"I love getting to know a family, getting to know their dynamics and how that all factors into their health care," Mizrahi said. "It's an honor to be incorporated into somebody's life like that."

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Family medicine residencies shrinking

Fewer seniors graduating from U.S. allopathic medical schools are interested in becoming family physicians. The number of family medicine residencies has decreased in the past 10 years. After a slight increase in 2008, family medicine took another drop in 2009.

Family medicine positions
Offered Filled U.S. seniors matching
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
2006 2,711 2,307 1,123
2007 2,603 2,299 1,096
2008 2,636 2,387 1,156
2009 2,535 2,311 1,071

Note: These numbers do not include family medicine slots in emergency medicine, internal medicine or psychiatry.

Source: National Resident Matching Program

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External links

National Resident Matching Program, data tables, 2009 residency Match (link)

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