Primary care's Match Day rebound still comes up short

After a slight dip in the 2012 Match, the share of fourth-year U.S. medical students opting for residencies in primary care specialties rose again in 2013. But physician organizations and medical schools warned that rising student interest in primary care is not enough to avert projected physician shortages and does not make up for the lack of graduate medical education slots available due to a cap on federal funding of such residency positions.

The number of U.S. seniors entering primary care residencies fell by less than 1% in 2012 but saw an increase of 5.5% in 2013. A total of 6,327 seniors opted for GME positions in family medicine, internal medicine and pediatrics. Nearly 700 more residency positions of all kinds were offered this year, yet the share of U.S. students choosing primary care still rose by 1.3% to 38.6% in 2013.

Among all residency applicants — U.S. seniors graduating in 2013, American students who graduated in prior years, foreign students who graduated from international medical schools and U.S. citizens who graduated from medical schools overseas — the number choosing primary care rose for the fifth straight year and is up 24% since 2009.

“I believe primary care is a very important field, and I want to contribute to that field,” says Ignacio Becerra-Licha, who did the couples match with his wife, Somalee Banerjee. They will enter primary care residencies in the San Francisco Bay Area after graduating from Washington University School of Medicine in St. Louis. Photo by Whitney Curtis / AP Images for American Medical News

About a third of the students graduating from Washington University School of Medicine in St. Louis opted for primary care residencies. Among them is Nathan Moore, whose selection was informed by research he did for a book he co-wrote with third-year Washington University medical student Elisabeth Askin. The Health Care Handbook, published electronically and in paperback by Washington University in 2012, aims to offer health profession students “a clear and concise guide” to the U.S. health care system and has sold more than 7,000 copies.

Teachers at more than a dozen schools are using the book to help students better understand health care delivery systems, health care financing, regulation, medical liability and other elements that often get little attention before students are thrust into clerkships.

Moore initially was leaning toward emergency medicine but changed course when he learned about impending shortages in primary care and how doctors in that specialty have a central role in improving care quality and lowering costs.

“Seeing the data, I thought working in primary care could have a big effect, and that had a huge impact on what I decided to do,” said Moore, who will start an internal medicine residency at Washington University-affiliated Barnes Jewish Hospital in July.

Students look to reach underserved

Ignacio Becerra-Licha, president of the 2013 medical school class at Washington University, also landed a primary care residency in the Match. Becerra-Licha did a couples match with his wife, Somalee Banerjee, also a Washington University student. He will be entering the University of California, San Francisco's family medicine residency program, while Banerjee landed an internal medicine slot at Kaiser Permanente in Oakland, Calif.

Becerra-Licha's family is from Puerto Rico, and he is fluent in Spanish as well as English. He hopes to make use of his language skills as a family physician to improve Hispanic health.

“One of the biggest reasons why I went into medicine is that I was interested in this Latino population, and I saw a big need for Spanish-speaking doctors,” he said.

Despite rising interest in primary care among U.S. medical students, the Assn. of American Medical Colleges still forecasts a shortage of 46,100 primary doctors by 2020. The AAMC sees a shortage of 45,400 doctors from other specialties by 2020. That is unlikely to change if the cap on Medicare-funded residency slots is not lifted, according to the AAMC, the American Medical Association and others.

Bipartisan House and Senate bills introduced March 14 would create an additional 15,000 Medicare GME slots, with half reserved for primary specialty training.

AMA President Jeremy A. Lazarus, MD, welcomed the proposed legislation. “We will continue to work with members of Congress to advance this important issue to meet the nation's need for more physicians,” he said.