Residency Match Results Not Encouraging for Adults Needing Primary Care
This is old news. Students love our rotations much more than they choose internal medicine.
According to the 2010 National Resident Matching Program report, 2,722 U.S. seniors at medical schools enrolled in an internal medicine residency program, a 3.4 percent increase from 2,632 in 2009. The internal medicine enrollment numbers are similar to 2008 (2,660), 2007 (2,680), and 2006 (2,668). In comparison, 3,884 U.S. medical school graduates chose internal medicine residency programs in 1985.
So we should be honest and evaluate the problem. Is internal medicine a poor career choice? Is the material uninteresting? Why do our graduates not choose internal medicine?
Dr. Weinberger sees the world clearly:
“Because it takes a minimum of three years of residency after four years of medical school to train an internist, it is critical to begin making careers in internal medicine attractive to young physicians,” said Dr. Weinberger. “As America's aging population increases and more people gain access to affordable coverage, the demand for general internists and other primary care doctors will drastically outpace the primary care physician supply.”
Increasing Medicaid and Medicare payments to primary care physicians, expanding pilot testing and implementation of patient-centered medical homes, and increasing support for primary care training programs are ways to increase the number of primary care physicians, according to ACP.
ACP remains concerned about the rising cost of medical education and the resulting financial burden on physicians who choose careers in internal medicine, Dr. Weinberger noted.
As I write repeatedly, we are getting the workforce that our payment system encourages. We know that excellent internists decrease costs and increase quality, but they are shown no respect from private insurers and CMS. Those payers reward procedures out of proportion to pure cognition and patient relationship. Those who do procedures certainly use cognition in addition to their procedures, but it appears to this observer that the payment for the procedure greatly outweighs the payment for excellent outpatient or inpatient care.
We can have the desired workforce if we made drastic and necessary changes. If is a huge word, and therefore I remain skeptical.
{ 4 comments… read them below or add one }
I believe there is no good answer to increasing numbers in primary care that does not simultaneously increase the number of residency slots available to all.
SO WHY IS EVERYONE BEING SO DUMB? IF GOOD INTERNISTS CAN BRING EXCELLENT VALUE,WHY ARE WE FOOLISH ENOUGH TO IGNORE THEIR WORTH??? SOMEONE PLEASE EXPLAIN – EVERYONE TALKS ABUT THIS BUT NOTHING IS HAPPENING TO HELP THE SITUATION> NO PRIDE TO BE GOOD INTERNIST. THE NURSE ANESTHETIST MAKING MORE THAN THESE DOCS IS TESTIMONY OF THIS!!
you still have to do internal medicine to be a cardiologist, gastroenterologist, or nephrologist. at least the last i checked.
are all those specialties falling out of favor as well?
I fear we will soon be past the point of no return with primary care. There will be too few of us for the politicians to bother with lip service.
The main problem as Dr. Centor often points out is that comprehensive care is little understood and severely undervalued even within medicine. How then can we expect political hacks and medicrats to act?
I’m an FP, for us I put a chunk of the blame on AAFP’s love affair with HMO gatekeeper models 2+ decades ago for cheapening the perception of what we do. If all the FP does is organize referrals and handle simple problems, why not hire an RN to do the same. Or a computer program. Or a call center in India. Policymakers and bureaucrats heard the message and have acted. All the AAFP blather since has failed to undo the damage.