Fewer U.S. Med Students Choosing Primary Care / Pay Gap, Other Factors May Lead to Shortage of First-Stop Doctors

Only 2 percent of graduating medical students say they plan to work in primary-care internal medicine. This is raising worries about a looming shortage of the first-stop doctors. The results of a new survey being published today suggest that more medical students, many of them saddled with debt, are opting for more lucrative specialties.

The survey of nearly 1,200 fourth-year students found just 2 percent planned to work in primary-care internal medicine. In a survey in 1990, the figure was 9 percent.

Paperwork, the demands of the chronically sick, and the need to bring work home are among the factors pushing young doctors away from careers in primary care, the survey found.

Dr. Karen Hauer of the University of California, San Francisco, the study’s lead author, said it’s hard work taking care of the chronically ill, the elderly and people with complex diseases – “especially when you’re doing it with time pressures and inadequate resources.”

The salary gap may be another reason.

Family medicine had the lowest average salary last year, $186,000, and the lowest share of residency slots filled by U.S. students, 42 percent. Orthopedic surgery paid $436,000, and 94 percent of residency slots were filled by U.S. students.

Meanwhile, medical school is getting more expensive. The average graduate last year had about $140,000 in student debt.

Lower salaries in primary care did not deter Dr. Alexis Dunne of Chicago, who is 31 and carrying $250,000 in student debt. She enjoys being “the point person” for her patients.

“You become so close to them, you’re almost like a family friend,” said Dunne, who completed her residency at Chicago’s Northwestern Memorial Hospital in July.

A separate study in JAMA suggests graduates from international medical schools are filling the primary care gap – so far.

About 2,600 fewer U.S. doctors were training in primary-care specialties – including pediatrics, family medicine and internal medicine – in 2007 compared with 2002. In the same span, the number of foreign graduates pursuing those careers rose by nearly 3,300.

However, Edward Salsberg of the Association of American Medical Colleges, a study co-author, said that “holding steady in numbers is probably not sufficient when the population is growing and aging.”

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Originally published by K. JOHNSON; The Associated Press.

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