Primary care residencies up again on Match Day

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More than 15,000 U.S. medical school seniors got a glimpse of their future at noon CDT March 17, as they simultaneously ripped open white envelopes revealing where they will do their residency training. For the second year in a row, more of them decided to train for primary care.

The increase is driven in part by a growing emphasis on primary care as the country moves forward with health system reform, said Roland Goertz, MD, president of the American Academy of Family Physicians.

"We believe an important element is recognition that primary care medicine is absolutely essential if we are to improve the quality of health care and help control its costs," said Dr. Goertz, a family physician in Waco, Texas.

U.S. seniors filled 1,301 family medicine positions, up 11.3% from 1,169 in 2010, according to the National Resident Matching Program. This year's U.S. medical school graduates filled 48% of available family medicine slots, up from 44.8% in 2010.

Internal medicine matches for U.S. seniors rose 8%, to 2,940 from 2,722 in 2010. This year's class of U.S. graduates filled 57.4% of available internal medicine slots, up from 54.5% in 2010. In internal and family medicine, a greater percentage of slots were filled by U.S. seniors even as the overall number of available positions increased.

Residencies not filled by U.S. seniors went to past medical school graduates, foreign graduates of international medical schools and American citizens who attended medical school abroad.

The number of U.S. seniors entering pediatrics internships rose 3.3%, to 1,768 in 2011 from 1,711 in 2010.

Though the gains are encouraging, they are only a fraction of what is needed, said Steven Weinberger, MD, executive vice president and chief executive officer of the American College of Physicians.

Rebecca Cantone, (left) and Emma Daisy, will enter family medicine residency training after they graduate in May from Northwestern University Feinberg School of Medicine in Chicago. They are among the growing number of U.S. medical students who choose to go into family medicine. "You feel like you're really making a difference," Daisy said. Photo by Ted Grudzinski/AMA

"We're cautiously optimistic and hope that the positive trend continues," Dr. Weinberger said. "But the U.S. still has to overcome a generational shift that resulted in decreased numbers of students choosing primary care as a career. In 1985, 3,884 U.S. medical school graduates chose internal medicine residency programs."

Seniors Emma Daisy, 31, and Rebecca Cantone, 25, are pursuing careers in family medicine. Both women want to treat urban poor and medically underserved populations after they graduate from Northwestern University Feinberg School of Medicine in May.

"In today's society, I feel like they kind of get lost in the whole medical system," said Cantone, of Orland Park, Ill.

Daisy, of Charlottesville, Va., said she initially planned to pursue obstetrics and gynecology but changed to family medicine her third year because she believes it will allow her to know patients better and make a difference in their lives.

"I think that family medicine is a really great career choice for the future of medicine," she said.

Watching students learn their placements on Match Day was moving, said Deborah Reed, MD, assistant professor in Northwestern's psychiatry department. She had mentored 45 of the seniors since they began medical school four years ago.

"I feel like a mother to them. My hands were shaking as I was handing out the envelopes and seeing the anticipation in their faces. You know how hard they've worked," she said at Northwestern's Match Day celebration at a pizza restaurant in Chicago.

Overall, 2011 was the first year the number of successful matches for U.S. seniors passed the 15,000 mark, equaling a match rate of 94%. Of those, 81% matched to one of their top three choices.

Northwestern senior Eric Chan, 25, got his top pick. This summer he will begin a psychiatry residency at the University of California, San Francisco. He was ecstatic when he learned the news. "I've been really nervous before today second-guessing whether I made the right decision," he said March 17. "Now I know I made the right decision."

Even though there was more interest in primary care, the interest in other specialties remained high. The most competitive slots for 2011 were dermatology, orthopedic surgery, otolaryngology, plastic surgery, radiation oncology, thoracic surgery and vascular surgery, according to the NRMP. At least 90% of the available residency slots in each of those specialties were filled by U.S. seniors.

Overall, the number of U.S. seniors entering their first year of residency training increased 4% to 15,588 over 14,992 last year.

"That's the result of not only enrollment increases in existing medical schools, but new medical schools coming on," said Mona M. Signer, NRMP executive director.

The 2011 Match offered 23,421 first-year and 2,737 second-year positions, 638 more overall than 2010. The overall number of residency positions filled by U.S. medical school seniors and graduates nationwide, including those entering first- and second-year residency positions, increased by 630, or 3.7%, over 2010 to 17,607 this year.