Primary care gets boost in resident Match

When students from the University of Chicago Pritzker School of Medicine opened their resident Match envelopes in March 2009, only one was bound for a family medicine residency. On Match Day 2010, 12 future family doctors were among the 114 students who unsealed their fates in an auditorium that exploded with shrieks of joy when the big moment arrived.

The family medicine shift among the University of Chicago seniors is indicative of a greater nationwide interest in primary care. There was a 9% rise in the number of U.S. allopathic medical school seniors choosing family medicine -- compared with a 7% drop in 2009.

The number of students matched to internal medicine, family medicine and pediatrics residencies rose 4% after falling slightly in 2008 and 2009. More primary care residency positions were offered in 2010, but the proportion of American allopathic grads choosing primary care also went up 1% over 2009.

Among all applicants in the National Resident Matching Program -- including U.S. allopathic students who graduated in previous years, international medical graduates, osteopathic students and others -- the number matched to primary care residencies increased 2.3% from 2009 to 2010. American grads filled 66% of the 25,520 residency positions available in all specialties. Other applicants filled another 7,401 positions, and 1,142 slots were left unfilled.

Physician leaders and medical school officials attributed the uptick in primary care residencies in part to the health system reform debate, which they say has focused renewed attention on the need for better primary care.

The shortage of family physicians was a factor in University of Chicago medical student Liz Brown's decision to enter family medicine.

"We need good primary care in this country, so I'm really excited to be part of a group of physicians that's going to provide it," said Brown, who is headed to the family medicine residency program at the Warren Alpert Medical School of Brown University and the Memorial Hospital of Rhode Island. "Money wasn't the driving force for me. It's providing good care to people who need it."

The turnaround for family medicine is significant and surprising given the difficult economy, said Lori Heim, MD, president of the American Academy of Family Physicians.

"In a year when one might expect that seniors would be more concerned about their personal finances, we're actually seeing that they're making a move toward family medicine," said Dr. Heim, a hospitalist at Scotland Memorial Hospital in North Carolina. "I attribute that directly to the increase in awareness of family medicine and primary care because of the health reform debate."

That and other measures, such as higher Medicare pay for evaluation and management services, sent a positive signal to students, she said. "There's been a lot for medical students to look at and say, 'This practice of family medicine that I want to do looks like it has a viable future.' "

Shortages still loom

But the 3% increase over 2009 in U.S. medical school seniors choosing internal medicine residencies does not necessarily mark a turning point in the search for more general internists, said Steven Weinberger, MD, deputy executive vice president of the American College of Physicians.

"Obviously, it's good to see that it's not been going down," said Dr. Weinberger, adjunct professor of medicine at the University of Pennsylvania School of Medicine. "But it's only 90 extra people. I think we still have a ways to go. ... It's certainly not enough to meet the needs in primary care, given the burgeoning baby boomer population."

Only about a quarter of internal medicine residents will wind up practicing as general internists, compared with more than half in 1998, the ACP said. Now, most IM residents subspecialize in higher-paying specialties.

Dr. Weinberger said systemic change is needed to attract a significantly higher proportion of U.S. medical students to primary care.

"The things that will make the difference are reforms in the model we have for patient care," he said. "The patient-centered medical home, developing a better system for team-based care, more appropriate reimbursement for primary care, some ability to help physicians with the tremendous time pressures they have in the delivery of primary care -- all those things are important."

About half of U.S. allopathic medical schools have instituted or are considering implementing programs and policies to encourage students to choose primary care specialties, according to the Assn. of American Medical Colleges. The messages that students get from faculty are influential, Dr. Heim and others said.

University of Chicago medical student Cameron Nienaber said she is familiar with the challenges facing primary care doctors, but she did not let that deter her from choosing family medicine.

"I've had some great mentors here at school who are family physicians, and they've kind of helped me work through some of those issues," said Nienaber, who is headed for the residency program at Brown. "One of the things that attracted me to family medicine in the first place is how happy people seemed in their jobs, even though maybe that's not the public hype that everyone hears."